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

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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.