Clinical predictors of second-line chemotherapy (ChT) benefit in pancreatic cancer (PC).

Abstract

e15733 Background: Second line ChT is shown to improve outcome in selected patients with PC; however there are no approved models predicting its benefit. This retrospective study was aimed to evaluate prognostic factors in patients with PC who had disease progression following 1st line ChT and their value in prediction of 2nd line ChT benefit. Methods: Records of PC patients treated in N.N. Blokhin Russian Cancer Research Center since 2000 to 2015 were analyzed. Inclusion criteria for this retrospective analysis were: morphologically confirmed PC, disease progression after 1st line ChT or adjuvant / induction ChT with ChT-free interval <6 months. The most common clinical factors were evaluated for prognostic significance in the Cox proportional hazards model with overall survival (OS) as the end-point. OS was calculated from the date of progression following previous ChT. Cutoff values for quantitative variables were determined using ROC curve analyses. Results: Records of 172 patients matched the inclusion criteria. Second line ChT was administered in 110 (64%) patients (47% of them received gemcitabine- and/or platinum-based doublets). The Cox multivariate analysis identified two independent prognostic factors: Karnofsky performance status (KPS) ≤70% and neutrophil-to-lymphocyte ratio (NLR) >5 at the time of disease progression after 1st line ChT (Table). Administration of 2nd line ChT improved outcome of patients with favorable prognosis (score ≤1): median OS increased from 1.7 to 5.5 months in groups without (n=23) and with (n=90) ChT, respectively (p=0.02). In patients with poor prognosis (score>1) there were no benefit by administration of 2nd line ChT: medians OS were 2.3 and 1.7 months in groups with (n=20) and without (n=39) ChT, respectively (p=0.23). Conclusions: This novel prognostic model can potentially predict 2nd line ChT benefit in patients with PC, however it needs to be validated in further trials. [Table: see text]

The Real-Life Efficacy of the Second Line Treatment Strategy in Advanced Pancreas Cancer

“…18 Pokataev et al reported that a Karnofsky performance status of ≤70% and an NLR>5 were independent poor prognostic indicators for OS in patients with advanced pancreatic cancer receiving second-line therapy. 19 In the most comprehensive study, which included approximately 400 patients and evaluated 50 parameters, age, smoking and performance status, liver metastases, ascites, pain, jaundice, duration of firstline treatment, and type of treatment regimen were identified as independent prognostic factors for OS. 20 Age, albumin level, ALP level, ECOG PS, CEA level, and NLR level were determined as prognostic factors for OS in our trial.…”

Comparison of Pancreatic Cancer Treatment Outcomes: A Real-World Data Analysis

“…Patients who received 1L FOLFIRINOX should receive gem + nab-P or gem monotherapy, those who received 1L gem + nab-P should receive either platinum-based therapy (Xelox, Gemox or OFF), irinotecan-based therapy (FOLFIRI, Nal-Iri, Nal-Iri + 5-FU-leucovorin) or uoropyrimidine, and patients who received 1L gem monotherapy should receive irinotecan monotherapy or uoropyrimidine after consideration of the condition of the patient (18). Most studies recommend 2L therapy for patients who are able to tolerate it, with a few studies describing prognostic factors for receiving and bene ting from 2L therapy (23,25,26). For example, Vienot et al (26) presented a prognostic model to predict which patients would bene t the most from 2L therapy.…”

“…Their study found that age, smoking status, liver metastases, ECOG performance status score, jaundice, duration of 1L treatment, type of 1L regimen and pain were prognostic factors. Pokataev et al (23) provided another prognostic model to predict which patients would bene t the most from 2L chemotherapy. In their study, poor Karnofsky performance status (less than 70%) and a neutrophil-tolymphocyte ratio > 5 (NLR) were independent negative prognostic factors for a bene t of 2L therapy.…”

“…In cases in which neither FOLFIRINOX nor gem + nab-P can be used because the patient has a ECOG score of 2 or higher or because of the risk of grades 3-4 AEs, gem monotherapy is still the preferred treatment (16). To date, a few studies have developed treatment options following the progression of disease after 1L treatment (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), but a reliable standard second-line (2L) or later-line…”