There is limited real-world evidence on the impact of treatment sequence on outcomes for patients with metastatic pancreatic cancer (mPC) treated with liposomal irinotecan (nal-IRI). This study assessed clinical characteristics and overall survival in patients that received nal-IRI in the third-line (3L) setting or beyond (3L+) following treatment with fluorouracil and gemcitabine-based treatment (Sequence 1), and patients who received nal-IRI as second-line treatment following gemcitabine-based frontline treatment (Sequence 2).
Using the Flatiron Health® longitudinal database, data were extracted and analyzed for adult patients with mPC treated with nal-IRI between November 2015 and October 2018. Lines of treatment were derived from structured medication administration and order data. Kaplan-Meier methods were used to estimate overall survival (OS) from nal-IRI initiation.
There were 121 Sequence 1 and 129 Sequence 2 patients included in this study. Sequence 1 patients had a median age of 66y (IQR 60 – 73) at nal-IRI initiation and Sequence 2 patients were 72y (IQR 65 – 77) at initiation. 65.1% of Sequence 2 patients (n=84) were initially diagnosed with Stage IV pancreatic cancer compared to 55.4% (N=67) of the Sequence 1 patients. ECOG scores were similar between the two cohorts; 52.1% (N=63) of Sequence 1 patients had a score of 0-1 compared to 52.7% (N=68) of Sequence 2 patients. Sequence 1 patients had a median OS of 4.1 months (95% CI, 3.5 – 5.4) from nal-IRI treatment initiation while Sequence 2 patients had a median OS of 6.3 months (95% CI 4.2 – 7.5).
This real-world analysis demonstrated similar results to a recent single center study conducted on nal-IRI treated patients and the NAPOLI-1 trial. Sequence 2 patients had a longer overall survival than Sequence 1 patients. Further real-world studies are needed to understand the impact of treatment sequences on survival outcomes in nal-IRI treated patients.
© 2019 Published by Elsevier Inc.