Meeting
2018 Gastrointestinal Cancers Symposium
Comparative effectiveness and safety of the implementation of universal public funding of FOLFIRINOX (FFX) and gemcitabine (G) + nab-paclitaxel (GnP) in advanced pancreatic cancer (APC): A population-based study.
Authors
Helen Guo
Cancer Care Ontario, Toronto, ON, Canada
Helen Guo , Jaclyn Marie Beca , Ruby Redmond-Misner , Wanrudee Isaranuwatchai , Lucy Qiao , Craig Earle , Scott R. Berry , James Joseph Biagi , Stephen Welch , Brandon Matthew Meyers , Nicole Mittmann , Natalie G. Coburn , Aliya Pardhan , Jessica Arias , Deborah Schwartz , Scott Gavura , Leta Marie Forbes , Robin McLeod , Erin Diane Kennedy , Kelvin K. Chan
Organizations
Cancer Care Ontario, Toronto, ON, Canada, Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada, Ontario Institute for Cancer Research, Toronto, ON, Canada, Odette Cancer Centre/ Sunnybrook Health Sciences Centre/ University of Toronto, Toronto, ON, Canada, Queen's University/ Cancer Centre of Southeastern Ontario, Kingston, ON, Canada, London Regional Cancer Program, London, ON, Canada, Juravinski Cancer Centre/ McMaster University, Hamilton, ON, Canada, HOPE Research Centre, Sunnybrook Hospital, Toronto, ON, Canada, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada, Hamilton Regional Cancer Center, Hamilton, ON, Canada, Mount Sinai Hospital, Toronto, ON, Canada, Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
Research Funding
Other
Background: FFX has been universally publicly funded in Ontario, Canada, for metastatic pancreatic cancer (mPC) and unresectable locally advanced pancreatic cancer (uLAPC) since 11/2011 and 04/2015, respectively. GnP has been publicly funded for uLAPC and mPC (APC) since 04/2015. We examined the real world comparative effectiveness and safety of implementing funding of FFX and GnP for patients with APC. Methods: Patients with APC who received first-line FFX, GnP, or G from 01/2008-03/2016 were identified in CCO’s New Drug Funding Program database and divided into 3 periods: 01/2008-10/2011 (P1), 11/2011-03/2015 (P2), and 04/2015-03/2016 (P3). Data were linked with the Ontario Cancer Registry and others to ascertain demographics, comorbidities, and outcomes. Matching weights of propensity score to simultaneously compare three periods were generated using multinomial logistic regression. Crude and adjusted survival analyses were conducted to assess overall survival (OS) using Kaplan-Meier and weighted Cox regression methods.Weighted negative binomial models were used to estimate rate ratios (RR) for all-cause hospitalization (H) and ED visits. Results: We identified 3696 patients (1250 in P1, 1891 in P2, 555 in P3) (overall mean age 65, female 46%). In P2, 49% received FFX. In P3, 53% received FFX and 35% received GnP. Median OS was 5.7, 7.0, and 7.5 months for P1, P2, and P3, respectively. Median OS for FFX and GnP in mPC were 8.8 and 5.5 months, respectively. OS was improved in P2 vs. P1 (HR = 0.84, 0.78-0.90) and in P3 vs. P2 (HR = 0.82, 0.73-0.92). ED visits were similar compared P2 vs. P1 (RR=1.02, p = 0.75) and P3 vs. P2 (RR=1.04, p = 0.48), and H was reduced in P2 vs. P1 (RR = 0.86, p = 0.01), but similar in P3 vs. P2 (RR = 0.98, p = 0.78). H for febrile neutropenia (FN) was increased in P2 vs. P1 (RR = 2.18, p = 0.04) but not in P3 vs. P2 (RR = 1.32, p = 0.45). Conclusions: Implementation of universal public funding of FFX for mPC improved OS and reduced the rates H overall, but increased FN-related H. Funding of FFX for uLAPC and GnP for APC improved OS without increased in ER and H.
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Abstract Details
Session Type
Poster Session
Session Title
Poster Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract
Track
Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract
Sub Track
Multidisciplinary Treatment
Citation
J Clin Oncol 36, 2018 (suppl 4S; abstr 375)
DOI
10.1200/JCO.2018.36.4_suppl.375
Abstract #
375
Poster Bd #
H12
Abstract Disclosures
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