The appropriate first-line chemotherapy regimen for incurable pancreatic cancer in clinical practice: A consideration of patients’ overall survival and quality of life

<b>Purpose</b>: For incurable pancreatic cancer, the therapeutic goal is to prolong survival and maintain the quality of life (QOL). Unexpected outpatient consultation (OCT) and emergency hospitalization lead to the deterioration of QOL. The National Comprehensive Cancer Network (NCCN) guidelines recommend FOLFIRINOX and nabPTX+GEM as the preferred first-line regimens. Japanese clinical practice guidelines further recommend GEM and S-1. At present, no treatment strategy considers QOL during patients’ entire clinical course. <b>Methods</b>: In this study, hospital-free survival (HFS), defined as the period without hospitalization and OCT, was introduced as a new indicator of the qualitative aspect of overall survival (OS). We compared OS, length of hospitalization (LOH), OCT, and HFS for the four first-line chemotherapy groups. <b>Results</b>: No significant difference was observed in the median OS and HFS, nor was there a strong correlation between OS and LOH, based on the four first-line chemotherapy groups. There were strong correlations between OS and OCT, and OS and HFS, in all first-line chemotherapy groups. The ratio of OCT to OS was similar for mFOLFIRINOX and nabPTX+GEM. S-1 had the lowest OCT-to-OS ratio. The ratio of HFS to OS declined from S-1, nabPTX+GEM, mFOLFIRINOX, and GEM, from highest to lowest. <b>Conclusion</b>: The appropriate first-line chemotherapy for incurable pancreatic cancer, ensuring OS and QOL, may be S-1, nabPTX+GEM, mFOLFIRINOX, and GEM, in that order; although, a bias for the elderly exists among S-1 group patients. In the future, when conducting clinical trials on chemotherapy, it may be necessary to examine QOL during the entire clinical course.The ethics committee of the Miyagi Cancer Center approved this study (approval number: 4). All procedures were performed according to the ethical standards of the institutional and national research committees, and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.<b><i></i></b> According to the local ethics policy for the retrospective analysis of our own anonymized clinical data, informed consent, with an opt-out option, was obtained from all patients.<br>