Abstract
Pancreatic cancer is one of the most lethal solid tumors. In many European countries gemcitabine plus nab-paclitaxel is the preferred first-line treatment. An increasing number of patients are eligible for second-line therapy, but the best regimen is still controversial. This study aimed to evaluate the efficacy of oxaliplatin-based compared to irinotecan-based therapies in this setting. 181 advanced pancreatic cancer patients consecutively treated in three centers with a second-line therapy progressed on gemcitabine plus nab-paclitaxel were retrospectively enrolled. OS and PFS were calculated using the Kaplan-Meier method and survival of the two groups was compared using the log-rank test. The median PFS and OS were respectively 3.5 (95%CI 3.2–3.8) and 8.8 months (95%CI 7.9–9.8) from second-line therapy in the overall population. The median PFS and OS were respectively 3.3 (95%CI 3.1–3.5) and 8.2 months (95%CI 7.24–9.34) with an irinotecan-based combination compared to 4.0 (95%CI 2.4–5.7) and 10.3 months (95%CI 8.62–12.02) in patients receiving an oxaliplatin-based combination. We observed a clear trend for longer survival outcomes with platinum-based doublet compared to regimens including irinotecan or nal-IRI. Head-to-head trials are still lacking. The neutrophil-to-lymphocyte ratio and the presence of liver metastases could drive physicians in tailoring the treatment strategy.
Highlights
Pancreatic cancer is one of the most lethal human malignancies, and the improvement of survival is one of the most urgent needs in cancer medicine [1,2]
We evaluated a consecutive series of 181 pancreatic cancer patients treated with second-line therapy previously progressed to gemcitabine and nab-paclitaxel (Figure 1)
We report a real-world experience of three referral centers for advanced pancreatic cancer patients receiving a second-line therapy previously progressed on gemcitabine plus nab-paclitaxel
Summary
Pancreatic cancer is one of the most lethal human malignancies, and the improvement of survival is one of the most urgent needs in cancer medicine [1,2]. Pancreatic cancer five-year relative survival rate remains at 7% and it is projected to become the second leading cause of cancer-related death by 2030 in Western countries [3,4]. The modest prolongation of pancreatic cancer patients’ survival in recent decades is in contrast to many other cancer types, in which screening, early detection, and novel treatments led to significant outcome improvements. About 80% of patients are not eligible for surgery due to local vascular involvement or distant metastases. Two novel chemotherapeutic regimens have been registered for the first-line treatment of patients with metastatic disease. In the PRODIGE/ACCORD phase III trial, FOLFIRINOX (folinic acid, fluorouracil, irinotecan, oxaliplatin) significantly improved median overall survival (OS)
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