Systemic anticancer therapy in patients with de novo metastatic pancreatic adenocarcinoma: A real-world analysis

This study used the ConcertAI Patient360 electronic health record dataset with linked claims. Adult patients were included if they were diagnosed with de novo mPDAC between January 2020 and March 2025 and had at least 3 months of follow-up, unless censored due to death. Exploratory analyses were performed to characterize patients who did not receive chemotherapy and to better understand the proportion who may have been eligible for treatment. Among treated patients, treatment discontinuation in the absence of disease progression was evaluated to assess treatment intolerance.

Of the 2708 patients meeting eligibility criteria, 953 patients (35%) did not receive systemic anticancer therapy (median age, 72 years). Among those patients not treated, 375 patients (39% of 953) had an ECOG PS of 0-1, and 161 patients (17% of 953) also had no obvious contraindications to systemic therapy or provider-documented reason for treatment ineligibility. Among the 1755 chemotherapy-treated patients (median age, 69 years), 1306 patients (74%) had an ECOG PS of 0-1. Overall, 911 (52%) of these patients discontinued treatment within 90 days of initiation. Furthermore, 603 (median age, 70 years) of the 911 patients discontinued treatment despite no documented evidence of disease progression.

In a large real-world population of patients with de novo mPDAC, over one-third did not receive chemotherapy, including patients who may have been eligible for treatment but remained untreated. Among chemotherapy-treated patients, approximately one-third discontinued treatment early in the absence of disease progression, suggesting potential chemotherapy intolerance. These findings further characterize patterns of systemic therapy non-treatment and early discontinuation among patients with mPDAC and potentially highlight a significant unmet need related not only to treatment efficacy but also to treatment tolerability and burden. A comparison of patient characteristics and outcomes between these populations and those who continue treatment is underway.