Clinical characteristics, molecular landscape and survival outcomes of metastatic pancreatic cancer from western India.

e16401 Background: Pancreatic cancer is an aggressive malignancy often diagnosed at an advanced, metastatic stage, leading to poor prognosis. Methods: This retrospective study included patients diagnosed with metastatic pancreatic cancer between March 2018 and September 2024. Survival analysis was performed using Kaplan-Meier method. Results: A total of 353 patients were included in the study, with a median age of 65 years (IQR 56–71) and F:M ratio of 1:1.3. Distribution of patients according to ECOG-PS (Eastern Cooperative Oncology Group-Perfomance Status) was : 0-1 in 270 patients (76.5%) and > = 2 in 83 patients (23.5%). A total of 302 patients (85.6%) had de novo metastatic disease, while 51 patients (14.4%) had metachronous metastases. Predominant sites of metastases were: liver (n = 250, 70.8%), distant lymph nodes (n = 142, 40.2%), lung/pleura (n = 70,19.8%), and peritoneum (n = 30 (8.5%). Pancreatic head was the most common site (44.4%), followed by body and tail (27.8% each). The median follow-up was 17.3 months (95% CI: 14.3–20.3) and 235 patients received systemic therapy, 65 were offered best supportive care alone while 53 patients were lost to follow-up. Most common first-line treatment regimens were Gemcitabine-nabpaclitaxel (GN) (n = 93) and FOLFIRINOX (n = 50). Median overall survival (mOS) for the whole cohort was 9.6 months (95% CI: 8.2–10.9) with 2-year OS of 20%. Patients who received GN had mOS of 12.2 months (95% CI: 8.1–16.3), while mOS among those who received FOLFIRINOX was 10.9 months (95% CI: 6.7–15.1) and it was 11.4 months (95% CI: 8.0–14.9) for those who received other regimens (p = 0.796). First-line PFS of the cohort was 8.4 months (95% CI: 6.8–9.9). Univariate and multivariate analysis showed that ECOG-PS > = 2, liver and lung metastases were poor prognostic factors for OS, while age < = 50, tumor location, first-line chemotherapy regimen were not found to be significant factors. Mutational analysis using NGS was performed in 111 patients, with most common alterations being KRAS (40.5%) and TP53 (36.9%). Additional alterations of interest included HER2 amplification (3.6%), BRCA1/2 (2.7%), BRAF (0.9%) and RET (0.9%). The mOS was 18.7 months for KRAS -mutant/ TP53 -wild-type, 14.5 months for KRAS -wild-type/ TP53 -mutant, 14.6 months for KRAS -mutant/ TP53 -mutant, and 18.3 months for KRAS -wild-type/ TP53 -wild-type tumors ( p = 0.477). Conclusions: This study demonstrates the real-world outcomes of metastatic pancreatic cancer highlighting that poor performance status, advanced stage at presentation and patient attrition remain key challenges and newer therapies are needed to improve survival outcomes.