B20 - Second-line chemotherapy in advanced pancreatic cancer patients before nab-paclitaxel introduction. Retrospective study in Reggio Emilia Clinical Cancer Centre

Abstract

Background: Only 1-2% of patients with advanced pancreatic survive at 5 years.FOLFIRINOX and nab-paclitaxel/gemcitabine regimens improved first-line treatment outcomes.There is no consensus on second-line setting.The aim of this study is to evaluate the second-line therapy impact in two time periods before nab-paclitaxel introduction. Material and methods: A retrospective observational single-center study was performed in Medical Oncology,Clinical Cancer Centre, IRCCS-Arcispedale S.Maria Nuova of Reggio Emilia. From 1/01/2009 to 31/12/2014, 204 consecutive patients received a first-line chemotherapy. Patients treated with second-line were evaluated in the two different time periods: before and after 2012 related to the introduction of FOLFIRINOX. Results: In two periods, 98 (48.5%) patients received a second-line.The main regimens used in first-line were gemcitabine in the first period (2009-2011) and FOLFIRINOX in the second period (2012-2014)(from 2012 to 2014 17 patients were treated with nab-paclitaxel/gemcitabine).We observed an increasing use of gemcitabine in the second period due to the reduction in use on the front line (52% patients post 2012 vs 21.4% before 2012); in the two periods there was no difference between oxaliplatin-based regimens(19 vs 21 patients).Table: B20First-lineHRStd. Err.ZP > z95% C.I.Nab-Paclitaxel/Gem vs Gem/Cape or GEMOX0.990.3300.990.51-1.92FOLFIRINOX vs Gem/Cape or GEMOX0.870.21-0.530.590.54-1.42FOLFOX or XELOX vs Gem/Cape or GEMOX2.060.971.540.120.81-5.21Gem or Cape vs Gem/Cape or GEMOX0.960.27-0.130.890.59-1.56Second-lineHRStd. Err.zP > z95% C.I.Nab-Paclitaxel/Gem vs FOLFOX or XELOX1.530.611.070.280,69-3.38FOLFIRINOX vs FOLFOX or XELOX0.690.24-1.040,290.34-1.38Gem or Cape vs FOLFOX or XELOX0.460.21-1.660,090.18-1.14Gem/Cape or GEMOX vs FOLFOX or XELOX0.730.22-1.020,300.40-1.33 Open table in a new tab In the two periods(2012-2014 vs 2009-2011)it was not observed a statistically significant improvement in overall survival (HR1.05;P = 0.33) and an increase of second-line chemotherapy treatment (HR 0.6; p = 1.24). Conclusions: We observed an increased of treatment with gemcitabine as second line after the introduction of FOLFIRINOX regimen, without an absolute increase of second-line chemotherapy use. With limits of a retrospective analysis,our data showed the same efficacy of second-line chemotherapy regardless of the first-line regimen employed.It will be interesting to compare our analysis with future data after the introduction of nab-paclitaxel in the first-line clinical practice.