Abstract
BackgroundIn recent years treatment options for advanced pancreatic cancer have markedly improved, and a combination regimen of gemcitabine and nab-paclitaxel is now considered standard of care in Sweden and elsewhere. Nevertheless, a majority of patients do not respond to treatment. In order to guide the individual patient to the most beneficial therapeutic strategy, simple and easily available prognostic and predictive markers are needed.MethodsThe potential prognostic value of a range of blood/serum parameters, patient-, and tumour characteristics was explored in a retrospective cohort of 75 patients treated with gemcitabine/nab-paclitaxel (Gem/NabP) for advanced pancreatic ductal adenocarcinoma (PDAC) in the South Eastern Region of Sweden. Primary outcome was overall survival (OS) while progression free survival (PFS) was the key secondary outcome.ResultUnivariable Cox regression analysis revealed that high baseline serum albumin (> 37 g/L) and older age (> 65) were positive prognostic markers for OS, and in multivariable regression analysis both parameters were confirmed to be independent prognostic variables (HR 0.48, p = 0.023 and HR = 0.47, p = 0.039,). Thrombocytopenia at any time during the treatment was an independent predictor for improved progression free survival (PFS) but not for OS (HR 0.49, p = 0.029, 0.54, p = 0.073), whereas thrombocytopenia developed under cycle 1 was neither related with OS nor PFS (HR 0.87, p = 0.384, HR 1.04, p = 0.771). Other parameters assessed (gender, tumour stage, ECOG performance status, myelosuppression, baseline serum CA19–9, and baseline serum bilirubin levels) were not significantly associated with survival.ConclusionSerum albumin at baseline is a prognostic factor with palliative Gem/NabP in advanced PDAC, and should be further assessed as a tool for risk stratification. Older age was associated with improved survival, which encourages further studies on the use of Gem/NabP in the elderly.
Highlights
In recent years treatment options for advanced pancreatic cancer have markedly improved, and a combination regimen of gemcitabine and nab-paclitaxel is considered standard of care in Sweden and elsewhere
Serum albumin at baseline is a prognostic factor with palliative Gem/Gemcitabine and nab-paclitaxel (NabP) in advanced Pancreatic ductal adenocarcinoma (PDAC), and should be further assessed as a tool for risk stratification
Univariable regression analyses The results of the univariable Cox regression analyses with hazard ratios (HR) for overall survival (OS) and progression free survival (PFS) are displayed in Tables 1 and 2, revealing that serum albumin before treatment start, Table 1 Univariable and multivariable analyses for OS data
Summary
In recent years treatment options for advanced pancreatic cancer have markedly improved, and a combination regimen of gemcitabine and nab-paclitaxel is considered standard of care in Sweden and elsewhere. A majority of patients do not respond to treatment. The majority of PDAC patients have disseminated disease already at diagnosis with tumour specific treatment options restricted to palliative chemotherapy. Improved survival has been achieved with different combination chemotherapy regimens such as FOLFIRINOX [3] and gemcitabine/nab-paclitaxel (Gem/ NabP) [4]. Due to its safety and tolerability profile, and since the combination was approved by the regulatory authorities in 2014, many centres in Sweden have preferred Gem/NabP as first line palliative treatment of advanced PDAC
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