Health-related quality of life for gemcitabine and nab-paclitaxel plus radiotherapy versus gemcitabine and S-1 plus radiotherapy in patients with metastatic pancreatic cancer

Abstract

PurposeTo compare the effects of gemcitabine and nab-paclitaxel (GT) plus stereotactic body radiation therapy (SBRT) or gemcitabine and S-1 (GS) plus SBRT on health-related quality of life (HRQOL) of metastatic pancreatic cancer.MethodsPatients with biopsy-proven and radiographically metastatic pancreatic cancer were included. HRQOL was assessed using the Chinese version of Brief Pain Inventory (BPI) and 5-level European quality of life 5-dimensions (EQ-5D-5L). Data were analyzed with Spearman’s rank correlation, ordinal regression, and propensity score-matched analysis.ResultsA total of 75 and 89 patients received GT and GS, respectively. The median biological effective dose of GT group and GS group was 59.5 Gy (range 48–85.5 Gy) and 64.4 Gy (range 52.48–85.5 Gy) in 5–8 fractions, respectively. More patients in the GS group had improvement in BPI and EQ-5D-5L compared with those in the GT group (n=38 vs n=15, P<0.001; n=42 vs n=20, P<0.001). No differences of BPI scores were found between pre- and post-treatment in each group, while only the post-treatment EQ-5D-5L score was higher than that at baseline in GS the group (P<0.001). Compared with GS group, it was unlikely for patients receiving GT to have better BPI and EQ-5D-5L. After propensity-matched analysis, more patients in GS group had improvement in BPI and EQ-5D-5L (n=24 vs n=12, P=0.002; n=28 vs n=16, P=0.002). Furthermore, patients with GS had a superior overall survival than those with GT (11.1 months [95% CI: 10.6–11.6 months] vs 9.9 months [95% CI: 8.8–11.0 months]; P=0.005). Both incidences of grade 3 hematological (P=0.024) and gastrointestinal (P=0.049) toxicities were higher in the GT group.ConclusionGS may achieve better HRQOL than GT. Therefore, GS may be an alternative of GT for metastatic pancreatic cancer, especially for Asians.

Comparisons of different neoadjuvant chemotherapy regimens with or without stereotactic body radiation therapy for borderline resectable pancreatic cancer: study protocol of a prospective, randomized phase II trial (BRPCNCC-1)

“…SBRT is performed after completion of the chemotherapy. The protocol of SBRT is similar to our previous studies [10–13]. Patients are required to be on fasting for 4–6 h before CT simulation.…”

Development and Validation of Multicenter Predictive Nomograms for Locally Advanced Pancreatic Cancer After Chemoradiotherapy

“…The nadir value of CA19-9 level after treatment was utilized for the estimation of CA19-9 decrease. Hence, CA19-9 response was stratified as follows: CA19-9 levels ≥74 U/ml with response vs. CA19-9 levels ≥74 U/ml with no response (including CA19-9 levels within the normal range before treatment while increasing after treatment) vs. CA19-9 levels <74 U/ml all along before and after treatment, which have been used in our previous studies (13)(14)(15). Furthermore, it was reported that patients with a CA19-9 level less than 200U/ml had major response when they received neoadjuvant therapy (16).…”

“…Irradiation of pancreatic cancer was performed with SBRT via CyberKnife ® (Accuray Incorporated, Sunnyvale, CA) delivered by 5-8 fractions, as described previously (13)(14)(15)18). Three gold fiducials within or adjacent to the pancreatic tumor were preferable.…”

Development and Validation of Multicenter Predictive Nomograms for Locally Advanced Pancreatic Cancer after Chemoradiotherapy

“…The nadir value of CA19-9 level after treatment was utilized for the estimation of CA19-9 decrease. Hence, CA19-9 response was strati ed as follows: CA19-9 levels ≥ 74 U/ml with response vs. CA19-9 levels ≥ 74 U/ml with no response (including CA19-9 levels within the normal range before treatment while increasing after treatment) vs. CA19-9 levels < 74 U/ml all along before and after treatment, which have been used in our previous studies [13][14][15]. Furthermore, it was reported that patients with a CA19-9 level less than 200 U/ml had major response when they received neoadjuvant therapy.…”

“…Irradiation of pancreatic cancer was performed with SBRT via CyberKnife® (Accuray Incorporated, Sunnyvale, CA), as described previously [13][14][15]18]. Three gold ducials within or adjacent to the pancreatic tumor were preferable.…”