Symptom changes that predict disease control by systemic chemotherapy in patients with advanced pancreatic cancer.

Abstract

195 Background: Alleviation of symptoms is related to good tumor control in patients undergoing systemic chemotherapy for pancreatic cancer (PC). The predictive value of symptom change has not been fully understood. The aim of this study was to identify symptom changes that predicted disease control by systemic chemotherapy in PC patients. Methods: Patients with unresectable PC who had not received any anti-cancer therapy for PC were eligible for inclusion in this study. Patients with obvious infectious conditions were excluded. Symptoms were scored from 0 to 10 using the Japanese version of the MD Anderson Symptom Inventory before the start of chemotherapy and one month later. The response of the tumor was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) vs. 1.0. Disease control was defined as CR, PR, or SD. An attempt was made to identify symptom changes that predicted disease control, and their impact on progression-free survival (PFS) was assessed. Results: The symptoms of 87 patients (male/female: 46/41, Karnofsky performance status (KPS): 100/90/80/70-50: 32/29/17/9, median age: 66 years) were prospectively assessed. Gemcitabine monotherapy (GEM), a GEM-based regimen, and S-1 monotherapy were performed in 42, 41, and 4 patients, respectively. Disease control was observed in 31 patients. The pain scores (P=0.047) and sleep disturbance scores (P=0.052) one month later were lower than before treatment in patients with disease control. Patients without deterioration of pain or sleep disturbance had a higher frequency of disease control (P=0.098 and P=0.004, respectively) and a longer PFS (P=0.021 and P<0.001, respectively) than patients whose pain or sleep disturbance became more severe. Conclusions: Improvements in pain and sleep disturbance scores at one month predict disease control by systemic chemotherapy in patients with advanced PC.