Objective: Characterize treatment chair time and survival among patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) by regimen and line of therapy (LOT).

Methods: The Flatiron Health Research Database was used to identify adult mPDAC patients initiating >1 LOT (1/1/2015–5/31/2021). Administration/chair times were based on product labeling, and excluded continuous infusions of fluorouracil (5-FU). Overall survival and chair time per month of follow-up (hrs/mo) were evaluated.

Results: 5,560 mPDAC patients were identified; ~80% (4,426) had 1LOT. Over half (56%) received gemcitabine+nab-paclitaxel (GnP), and 25% received FOLFIRINOX (FFX). 12%, 5%, and 2% of patients with 1LOT received gemcitabine monotherapy, FOLFOX, or liposomal irinotecan+5-FU/LVs (NAPOLI), respectively. Median survival was longest with NAPOLI (7.3 months [95%CI: 6.1–11.0 months]) and shortest with FOLFOX (3.5 months [95%CI: 3.0–4.3 months]). Chair time was longest for FFX (3.9 hrs/mo [IQR: 2.4–5.6 hrs/mo]) and shortest for gemcitabine monotherapy (0.9 hrs/mo [IQR: 0.5–1.4 hrs/mo]). 1,055 patients had 2 LOT, and the majority received FFX→ GnP (51%) or GnP→ NAPOLI (20%). 17% and 13% of patients received GnP → FFX or GnP→ FOLFOX, respectively. GnP→ NAPOLI had the longest median survival among 2 LOT sequences (11.9 months [95%CI: 11.0–12.5 months]). Chair times were lowest in GnP→ NAPOLI and GnP→ FOLFOX at 2.4 hrs/mo (IQRs: 1.6–3.0 hrs/mo and 1.9-2.9 hrs/mo, respectively) and highest for FFX→ GnP at 3.9 hrs/mo (IQR: 2.9–4.8 hrs/mo). 79 (1.4%) patients received the 3LOT sequence FFX→ GnP→ NAPOLI (median survival 17.7 months [95% CI: 15.1–21.2 months]). Median chair time was 3.9 hrs/mo (IQR: 3.1–4.7 hrs/mo), comparable to 2-LOT FFX→ GnP.

Conclusions: FFX containing sequences had longer chair times per month of follow-up. NAPOLI containing sequences had longer median survival and lower cumulative chair times than 2 LOT sequences not containing NAPOLI.