Treatment considerations in patients with metastatic pancreatic cancer who did not receive systemic therapy: A population-based study

BACKGROUND: Patients with metastatic pancreatic cancer (mPAC) may not receive systemic treatment (ST), yet determinants of not receiving ST in this setting remain poorly defined. This nationwide study aims to identify clinical and demographic factors associated with not receiving ST in patients with mPAC.

METHOD: Patients with synchronous mPAC from the Netherlands Cancer Registry were included (2015-2023). Multivariable logistic regression, Kaplan Meier survival curves and multivariable multinomial regression using percentile 25 and 75 of survival time were performed.

RESULTS: Among 13,756 patients with mPAC, 72% did not receive ST. Independent predictors of no-ST included increasing age, worse WHO PS (>0-1), modified Glasgow Prognostic Score (mGPS) 1-2, Charlson Comorbidity index ≥ 2, and low socioeconomic position. Reason for not receiving ST was mostly due to patient and family preference (39%), followed by patient factors (31%, comorbidity or impaired performance status (PS)). Half of patients not receiving ST had a good PS (WHO 0-1) (50%), while this was 68% when not receiving ST was based on preference. Median overall survival was 42 days (no-ST) versus 213 days (ST). In patients with no-ST, older age, PS of 3-4, mGPS 1-2, and peritoneum only or multiple organ sites with metastases were associated with worse survival, whereas lung- and lymph node-only metastases were associated with better overall survival.

CONCLUSION: In this nationwide study, a large majority of patients with synchronous mPAC did not receive ST, mostly based on preference and patient health factors. Our findings highlight the need for individualized prognostic assessment, and evidence-based shared decision-making.