Cancer Res Treat.  2020 Jan;52(1):254-262. 10.4143/crt.2019.190.

Clinical Outcomes of Second-Line Chemotherapy after Progression on Nab-Paclitaxel Plus Gemcitabine in Patients with Metastatic Pancreatic Adenocarcinoma

• Lee K
• Bang K
• Yoo C
• Hwang I
• Jeong JH
• Chang HM
• Oh D
• Song TJ
• Park DH
• Lee SS
• Lee SK
• Kim MH
• Park Jh
• Kim Kp
• Ryoo BY

• KMID: 2501217
• DOI: http://doi.org/10.4143/crt.2019.190

Abstract

Purpose
Since the introduction of nab-paclitaxel plus gemcitabine (nab-P+GEM) as first-line (1L) treatment for metastatic pancreatic adenocarcinoma (mPDAC), optimal second-line (2L) chemotherapy after progression is unclear. We assessed clinical outcomes of 2L chemotherapy for disease that progressed on 1L nab-P+GEM.
Materials and Methods
Among the 203 patients previously treated with 1L nab-P+GEM for mPDAC at Asan Medical Center, between February and December 2016, records of 120 patients receiving 2L chemotherapy after progression on nab-P+GEM were retrospectively reviewed. The response rate and survival were evaluated along with analysis of prognostic factors.
Results
Fluoropyrimidine-oxaliplatin doublets (FOLFOX or XELOX) were used in 78 patients (65.0%), fluoropyrimidine monotherapy in 37 (30.8%), and liposomal irinotecan plus fluorouracil in two (1.7%). The median progression-free survival (PFS) and overall survival (OS) were 3.29 months and 7.33 months from the start of 2L therapy. Fluoropyrimidine-oxaliplatin regimens and fluoropyrimidine monotherapy did not yield significantly different median PFS (2.89 months vs. 3.81 months, p=0.40) or OS (7.04 months vs. 7.43 months, p=0.86). A high neutrophil-lymphocyte ratio (> 2.2) and a short time to progression with 1L nab-P+GEM (< 6.4 months) were independent prognostic factors of poor OS with 2L therapy.
Conclusion
2L fluoropyrimidine-oxaliplatin doublets and fluoropyrimidine monotherapy after failure of 1L nab-P+GEM had modest efficacy, with no differences in treatment outcomes between them. Further investigation is warranted for the optimal 2L chemo-regimens and sequencing of systemic chemotherapy for patients with mPDAC.

Keyword

Pancreatic neoplasms; -paclitaxel; Gemcitabine; Oxaliplatin; Second-line

Figure

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  Fig. 1. Kaplan-Meier analyses of second-line progression-free survival (blue line) and overall survival (red line) in all 120 patients. CI, confidence interval.

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  Fig. 2. Progression-free survival (PFS) (A) and overall survival (OS) (B) with second-line chemotherapy after progression on nab-paclitaxel plus gemcitabine (nab-P+GEM). 2L, second-line; CI, confidence interval.

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  Fig. 3. Overall survival (OS) from the start of first-line nab-paclitaxel plus gemcitabine (nab-P+GEM) according to the second-line chemotherapy regimen. CI, confidence interval.

Reference

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