Outcomes of patients with metastatic pancreatic cancer who progress on first restaging imaging

Background: Objective responses to first-line systemic chemotherapy in metastatic pancreatic cancer patients are seen in less than one third of cases. Unfortunately, a significant amount will have disease progression (PD) on their first restaging imaging. With patients’ short life expectancy, it is crucial for clinicians to be prudent when deciding whom and when to treat. Our study aimed to evaluate outcomes of patients that progressed on their first restaging imaging on 1^st line therapy. Methods: We retrospectively analyzed patients diagnosed between 2010–2017 whose first restaging imaging demonstrated PD. The primary outcome was overall survival (OS) from metastatic diagnosis date to death. Patients who were lost to follow-up were excluded. Results: Out of 262 total patients reviewed, 98 patients (37%) were included. Sixty-five (66%) received 2^nd line therapy, and 33 (34%) did not. Reasons patients did not pursue 2^nd line therapy were performance status (PS) decline, organ dysfunction, or patient choice for alternative therapy. Median ages for patients who did and did not receive 2^nd line therapy were 61 and 67, respectively (P<0.001). More patients had a poor PS at the time of initial diagnosis in the non-2^nd line therapy group (7.5% vs. 31.0%, P=0.021). Median OS for those receiving 2^nd line therapy was 9 months (95% CI: 7–11 months) compared to 4 months (95% CI: 3–5 months) for those not receiving 2nd-line therapy (P<0.001). Conclusions: Although likely biased due to better performance status and younger age, our patients who progressed rapidly on 1^st line therapy showed an OS benefit if they received 2^nd line therapy. These results suggest that patients maintaining a good PS after immediate progression on 1^st line therapy should be offered 2^nd line therapy.