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Cancer Medicine - 2025 - Youlden - Treatment and Survival for Unresectable Pancreatic Adenocarcinoma in Queensland 1.24 MB
Published VersionCC BY V4.0, Open Access
Journal article
Treatment and Survival for Unresectable Pancreatic Adenocarcinoma in Queensland, Australia, 2018–2022
Cancer Medicine, Vol.14(17), pp.1-10
2025
PMID: 40916975
Abstract
Background: The three main chemotherapy regimens for people with unresectable pancreatic cancer include modified FOLFIRINOX (comprising oxaliplatin, irinotecan and fluorouracil, denoted mFFX), gemcitabine with nab-paclitaxel (GnP), and single-agent gemcitabine (GEM). We explored characteristics associated with the type of chemotherapy and variations in survival.
Materials and Methods: Records for people with unresected pancreatic adenocarcinoma between 2018 and 2022 treated with first-line mFFX, GnP or GEM were extracted from the population-based Queensland Oncology Repository. Multivariable Poisson models were fitted to determine factors associated with each type of chemotherapy, expressed as relative likelihoods (RLs). Variations in three-year observed survival were assessed using flexible parametric modelling and reported in terms of adjusted excess mortality hazard ratios (HRs).
Results: Of the 766 people in the study cohort, 59% were treated with GnP, 27% with mFFX, and 15% with GEM. After adjustment, treatment with mFFX was far more likely in selected private facilities compared to public hospitals (RL = 2.33, 95% CI 1.84–2.96), whereas the GEM regimen was used more often for those from outer regional/remote areas (RL = 2.20 compared to people living in major cities, 95% CI 1.45–3.34; p < 0.001). Three-year survival was very poor at just 5% (95% CI 3%–7%). Nonetheless, adjusted mortality was higher for GnP (HR = 1.30, 95% CI 1.07–1.59) and GEM (HR = 1.53, 95% CI 1.17–2.01) compared to mFFX.
Conclusions: Apart from clinical indications, there should be equity in the treatment received for unresectable pancreatic cancer. Our results suggest, however, that where a person lives and the type of facility at which they are treated may influence their chemotherapy regimen.
Details
- Title
- Treatment and Survival for Unresectable Pancreatic Adenocarcinoma in Queensland, Australia, 2018–2022
- Authors
- Danny R. Youlden - Metro South HealthBryan A. Chan - University of the Sunshine Coast, Queensland, Centre for BioinnovationJon Clark - Metro South HealthVictoria K. Donoghue - Metro South HealthMichael J. Allen (Corresponding Author) - Sunshine Coast University Hospital
- Publication details
- Cancer Medicine, Vol.14(17), pp.1-10
- Publisher
- John Wiley & Sons Ltd.
- Date published
- 2025
- DOI
- 10.1002/cam4.71226
- ISSN
- 2045-7634
- PMID
- 40916975
- Copyright note
- This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.
- Data Availability
- The unit record data used in this study are not publicly available to pro- tect patient privacy and confidentiality. Deidentified data may be avail- able from the corresponding author on reasonable request.
- Organisation Unit
- School of Health; Centre for Bioinnovation
- Language
- English
- Record Identifier
- 991167745402621
- Output Type
- Journal article
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- Oncology
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