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Predictive Impact of Clinical Benefit in Chemotherapy-treated Advanced Pancreatic Cancer Patients in Northern Alberta

Kim, Christina A., MD*; Chu, Quincy S.C., MD; Fassbender, Konrad, PhD‡,§; Ghosh, Sunita, PhD; Spratlin, Jennifer L., MD

American Journal of Clinical Oncology: September 2018 - Volume 41 - Issue 9 - p 867–873
doi: 10.1097/COC.0000000000000385
Original Articles: Gastrointestinal

Objectives: Patients with advanced pancreatic cancer (APC) have a poor prognosis and experience a large burden of disease-related symptoms. Despite advancements in the treatment of APC, survival is dismal and controlling disease-related symptoms and maintaining quality of life is paramount. We hypothesize that an improvement in disease-related symptoms, and therefore, a clinical benefit, while on chemotherapy is a predictive marker in APC.

Materials and Methods: Patients 18 and older with APC diagnosed between January 1, 2005 and December 31, 2010 and treated at the Cross Cancer Institute were identified using the provincial cancer registry. Disease symptoms were assessed at baseline and clinical benefit while on chemotherapy was defined using a composite endpoint of improvement in patient-reported pain, opioid consumption, Eastern Cooperative Oncology Group performance status, and/or weight. Best radiologic response, progression-free survival (PFS), and overall survival (OS) were recorded.

Results: Of 103 patients, the median age was 64, 58% were male and 66% had metastatic disease. At baseline, the majority of patients reported pain (80%), opioid use (61%), or weight loss (71%). In total, 35 (34%) patients received a clinical benefit with treatment but only 6 (17%) of these patients experienced a radiologic response. The median PFS and OS were improved in patients who experienced a clinical benefit (6.6 vs. 4.6 mo; P=0.03 and 11.7 vs. 6.1 mo; P<0.0001, respectively).

Conclusions: In patients with APC treated with chemotherapy, experiencing a clinical benefit was associated with improved PFS and OS. However, it did not appear to correlate with radiologic response to chemotherapy. Prospective studies are warranted to further investigate the prognostic and predictive value of clinical benefit and improvement in quality of life as measured by standardized tools, in APC.

*Department of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB

Covenant Health Palliative Institute

Department of Medical Oncology

§Division of Palliative Care Medicine, University of Alberta, Edmonton, AB, Canada

Supported by Canadian Institute for Health Research/Canadian Association of Medical Oncologists.

The authors declare no conflicts of interest.

Reprints: Christina A. Kim, MD, Department of Medical Oncology and Haematology, University of Manitoba, 409 Tache Avenue, Winnipeg, MB, Canada, R2H 2A6. E-mail: ckim3@cancercare.mb.ca.

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