Introduction: Recently, FOLFIRINOX and gemcitabine + nab-paclitaxel have been introduced
as a novel intensified chemotherapy regimen for patients with metastasized pancreatic
cancer. This study aims to analyze the real-world clinical practice with FOLFIRINOX
and gemcitabine + nab-paclitaxel across Europe. Methods: Invitations to participate
in an anonymous web-based questionnaire were sent via e-mail to 5,420 doctors in 19
European countries through the network of national gastroenterological, oncological,
surgical and pancreatic societies as well as the European Pancreatic Club. The questionnaire
consisted of 20 questions, 14 regarding the use of intensified chemotherapy, 4 regarding
demographics of the participants, and 1 to verify the active involvement in the management
of metastatic pancreatic cancer. Results: Two hundred and thirteen responses were
received and 153 entries were valid for analysis. Of those, 63.4% came from an academic
institution, 51% were oncologists, and 52% treated more than 25 cases per year. A
majority of responses (71%) were from Italy (40%), Germany (23%), and Spain (8%).
As first-line therapy, 11% used gemcitabine +/- erlotinib, 42% used FOLFIRINOX, and
47% used gemcitabine + nab-paclitaxel. Of the intensified regimens, both were applied
to equal parts, but the likelihood of protocol deviation was higher when using FOLFIRINOX
( p < 0.01). FOLFIRINOX was considered more toxic than gemcitabine + nab-paclitaxel
(neutropenia 88 vs. 68%; polyneuropathy 42 vs. 41%; rapid deterioration 42 vs. 31%).
FOLFIRINOX was rated to achieve longer survival with an acceptable quality of life
(52 vs. 44%). Moreover, 57% of participants thought that gemcitabine + nab-paclitaxel
should be the backbone for further clinical trials in pancreatic cancer. Conclusion:
Intensified chemotherapy is widely used in pancreatic cancer patients in Europe following
its recent clinical approval. Interestingly, nab-paclitaxel and FOLFIRINOX were used
at comparable frequency although the latter had to be de-escalated more often.