Real-world management and outcome of patients with pancreatic adenocarcinoma. Results of the Spanish RETUD gastrointestinal registry

Abstract

Background: Patient registries better reflect real-world management and outcomes of pancreatic cancer (PC) compared with clinical trials. Patients and methods: The main objective was to characterize patterns of care and outcomes in patients with exocrine PC included in the Spanish gastrointestinal RETUD registry. All analyses are descriptive in nature; therefore, P values are not reported. Results: A total of 1438 patients with a median age of 68.7 years (range: 34-94 years) were included between 1 January 2019 and 31 December 2022. 79.7% of patients had an Eastern Cooperative Oncology Group performance status of 0-1. 54.9% of resectable patients received adjuvant chemotherapy after upfront surgery, with a median overall survival (mOS) of 33.3 months (range: 26.1 months-not reached) for those treated with Folfirinox. 79.5% of metastatic patients received first-line chemotherapy, primarily gemcitabine and nab-paclitaxel (62.6%), with a mOS of 8.7 months (range: 7.1-9.6 months). Overall, 1-and 3-year net survival rates were 46% and 9%, respectively, with a clear increase for resectable/borderline stages. KRAS, microsatellite instability (MSI), and germline BRCA1/2 were determined in 16.4% (81.8% mutated), 21.2% (1.6% MSI-high), and 9.2% (12.8% mutated) of patients, respectively. Conclusions: Our study provides a real-world perspective on PC patients in Spain, revealing very poor survival similar to those reported in population-based and epidemiological studies. Notably, resectable PC patients receiving adjuvant chemotherapy had lower survival compared with those in clinical trials, a trend not observed in more advanced stages. Adherence to international guidelines varied, and clinical trial participation was low. Additionally, access to molecular testing was limited, remaining a significant challenge.