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Clinical Studies

Early onset pancreatic cancer—exploring contemporary treatment and outcomes using real-world data

British Journal of Cancer (2024)Cite this article

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Abstract

Background

Pancreatic cancer incidence is increasing in younger populations. Differences between early onset pancreatic cancer (EOPC) and later onset pancreatic cancer (LOPC), and how these should inform management warrant exploration in the contemporary setting.

Methods

A prospectively collected multi-site dataset on consecutive pancreatic adenocarcinoma patients was interrogated. Patient, tumour, treatment, and outcome data were extracted for EOPC (≤50 years old) vs LOPC (>50 years old).

Results

Of 1683 patients diagnosed between 2016 and 2022, 112 (6.7%) were EOPC. EOPC more frequently had the tail of pancreas tumours, earlier stage disease, surgical resection, and trended towards increased receipt of chemotherapy in the curative setting compared to LOPC. EOPC more frequently received 1st line chemotherapy, 2nd line chemotherapy, and chemoradiotherapy than LOPC in the palliative setting. Recurrence-free survival was improved for the tail of pancreas EOPC vs LOPC in the resected setting; overall survival was superior for EOPC compared to LOPC across the resected, locally advanced unresectable and metastatic settings.

Conclusions

EOPC remains a small proportion of pancreatic cancer diagnoses. The more favourable outcomes in EOPC suggest these younger patients are overall deriving benefits from increased treatment in the curative setting and increased therapy in the palliative setting.

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Fig. 1: Consort diagram and incidence by age at diagnosis.
Fig. 2: Recurrence- and progression-free survival by stage of disease.
Fig. 3: Recurrence-free survival in resected patients by tumour location and type of surgery.
Fig. 4: Overall survival by stage of disease.

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Data availability

The data underlying this study will be shared on reasonable request to the corresponding author.

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Acknowledgements

Michael Harold and Julie Johns at WEHI and BioGrid Australia for data collection and collation. Joanna Oakley for editorial assistance. Eastern Health Research Foundation—APH Philanthropic Foundation Research and Innovation Grant 2020. Epworth Medical Foundation. Poster presentation at the American Society of Clinical Oncology (ASCO) 2022 Gastrointestinal Cancers Symposium, January 20–22 2022 [26].

Funding

The PURPLE translational registry receives philanthropic support from the Hemstritch Foundation and the Pancare Foundation. BL is the recipient of the Hemstritch Centenary Fellowship.

Author information

Authors and Affiliations

  1. Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia

    Shehara Mendis, Yat Hang To, Peter Gibbs & Belinda Lee

  2. Cabrini Health, Malvern, VIC, Australia

    Lara Lipton & Val Usatoff

  3. University of Melbourne, Parkville, VIC, Australia

    Yat Hang To, Sumitra Ananda, Sue-Anne McLachlan, Mehrdad Nikfarjam, Peter Gibbs & Belinda Lee

  4. Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia

    Yat Hang To, Sumitra Ananda, Michael Michael & Belinda Lee

  5. Department of Medical Oncology, St Vincent’s Hospital, Fitzroy, VIC, Australia

    Sue-Anne McLachlan

  6. Department of Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia

    Benjamin Thomson, Benjamin Loveday & Brett Knowles

  7. Department of Surgical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia

    Benjamin Thomson, Benjamin Loveday & Brett Knowles

  8. Epworth Healthcare, Melbourne, VIC, Australia

    Brett Knowles & Rachel Wong

  9. Department of Hepatobiliary Surgery, St Vincent’s Hospital, Fitzroy, VIC, Australia

    Adrian Fox

  10. Department of Hepatobiliary Surgery, Austin Health, Heidelberg, VIC, Australia

    Mehrdad Nikfarjam

  11. Department of Medicine, Alfred Hospital, Prahran, VIC, Australia

    Julia Shapiro

  12. Department of Medical Oncology, Wellington Hospital, Wellington, New Zealand

    Kate Clarke

  13. Department of Medicine, Dunedin School of Medicine, University of Otago, Otago, New Zealand

    Sharon Pattison

  14. Department of Hematology-Oncology, National University Cancer Institute, Singapore, Singapore

    Cheng Ean Chee

  15. Department of Medical Oncology, Orange Hospital, Orange, NSW, Australia

    Rob Zielinski

  16. Department of Medical Oncology, Dubbo Base Hospital, Dubbo, NSW, Australia

    Rob Zielinski

  17. Department of Medical Oncology, Bathurst Base Hospital, West Bathurst, NSW, Australia

    Rob Zielinski

  18. Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia

    Rachel Wong

  19. Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia

    Rachel Wong

  20. Department of Medical Oncology, Northern Hospital, Epping, VIC, Australia

    Belinda Lee

Authors
  1. Shehara Mendis
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  2. Lara Lipton
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  3. Yat Hang To
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  4. Sumitra Ananda
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  5. Michael Michael
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  6. Sue-Anne McLachlan
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  7. Benjamin Thomson
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  8. Benjamin Loveday
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  9. Brett Knowles
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  10. Adrian Fox
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  11. Mehrdad Nikfarjam
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  12. Val Usatoff
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  13. Julia Shapiro
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  14. Kate Clarke
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  15. Sharon Pattison
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  16. Cheng Ean Chee
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  17. Rob Zielinski
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  18. Rachel Wong
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  19. Peter Gibbs
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  20. Belinda Lee
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Contributions

SM was involved in conception, design, analysis, drafting and revision. SM had full access to the data and holds final responsibility for the decision to submit for publication. LL acquired the data, was involved in the design, revised the manuscript and approved the final version. YHT interpreted results, revised the manuscript and approved the final version. SA acquired data, revised the manuscript and approved the final version. MM acquired data, revised the manuscript and approved the final version. SAM acquired data, revised the manuscript and approved the final version. BT acquired data, revised the manuscript and approved the final version. BJ acquired data, revised the manuscript and approved the final version. BK acquired data, revised the manuscript and approved the final version. AF acquired data, revised the manuscript and approved the final version. MN acquired data, revised the manuscript and approved the final version. VA acquired data, revised the manuscript and approved the final version. JS acquired data, revised the manuscript and approved the final version. KC acquired data, revised the manuscript and approved the final version. SP acquired data, was involved in the design, revised the manuscript and approved the final version. CEC acquired data, revised the manuscript and approved the final version. RZ acquired data, revised the manuscript and approved the final version. RW acquired data, revised the manuscript and approved the final version. PG was involved in the conception, design, revised the manuscript and approved the final version. BL was involved in conception, design, revised the manuscript and approved the final version.

Corresponding author

Correspondence to Shehara Mendis.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The (Pancreatic Cancer: Understanding Routine Practice and Lifting End Results (PURPLE). A Prospective Pancreatic Cancer Clinical Registry) PURPLE registry has ethics approval through the Melbourne Human Research Ethics Committee (Ethics approval number 2016.200), is listed on the Australia New Zealand Clinical Trials Registry, registration number ACTRN12617001474347, and operates under a waiver of consent. The Human Research Ethics Committee at each of the participating sites approved this study (HREC/17/MH/38). The study was performed in accordance with the Declaration of Helsinki.

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Mendis, S., Lipton, L., To, Y.H. et al. Early onset pancreatic cancer—exploring contemporary treatment and outcomes using real-world data. Br J Cancer (2024). https://doi.org/10.1038/s41416-024-02619-5

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