Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic Cancer

Gränsmark, Emma; Bylin, Nellie Bågenholm; Blomstrand, Hakon; Fredrikson, Mats; Åvall‐Lundqvist, Elisabeth; Elander, Nils

doi:10.3389/fonc.2020.01176

Cited by 17 publications

(19 citation statements)

References 22 publications

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“…We could not confirm our hypothesis that a doubling of CA 19-9 between the start and end of FL therapy would be a negative prognostic factor. In contrast, a recent retrospective study by Gr€ ansmark et al, including 167 patients with advanced pancreatic cancer, found that CA 19-9 above the median value was an independent poor prognostic factor for OS on SL treatment, resulting in a HR for death of 2.03 (p ¼ .009) [25]. As we applied different approaches to assessing changes in CA 19-9, our results are not comparable to these.…”

Section: Discussioncontrasting

confidence: 99%

Second-line palliative chemotherapy, survival, and prognostic factors in patients with advanced pancreatic cancer

et al. 2021

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Introduction: Pancreatic cancer is a highly lethal disease with a close association between incidence and mortality. First-line (FL) palliative chemotherapy prolongs survival and alleviates cancer-related symptoms. However, the survival benefit of second-line (SL) treatment is uncertain, as studies fail to consistently show prolonged survival for any given SL treatment, and in the absence of prognostic factors patients will receive a futile treatment. The aim of this study was to examine prognostic factors and survival in patients with pancreatic cancer, with special reference to SL therapy. Material and methods: This retrospective study included all patients with histopathologically verified pancreatic adenocarcinoma who received palliative chemotherapy at Skåne University Hospital and died between 1 Feb 2015 and 31 Dec 2017. Results: During the study period, a total of 170 patients with pancreatic cancer died after receiving palliative chemotherapy. Of these, 72 had received SL treatment after progression on FL treatment. Median overall survival (OS) from the start of SL treatment was 5.0 months (95% CI: 4.0-6.1). Median OS was 2.9 months for patients with performance status 2 at start of SL treatment compared to 5.3 months for patients with performance status 0-1 (p ¼ .03), and 3.5 months (95% CI: 3.0-5.4) in patients with hypoalbuminemia (<36 g/L) at the start of SL therapy compared to 8.0 months (95% CI: 5.3-11.1) for patients with normal albumin levels (p ¼ .009). Weight loss during FL therapy, a doubling of CA 19-9 after FL therapy, and length of progression-free survival during FL treatment were not associated with survival following SL therapy. Conclusion:Poor performance status and hypoalbuminemia are negative prognostic factors for survival on SL palliative treatment in patients with advanced pancreatic cancer. Possible gain in survival should be carefully considered before initiating SL chemotherapy.

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Section: Discussioncontrasting

confidence: 99%

Second-line palliative chemotherapy, survival, and prognostic factors in patients with advanced pancreatic cancer

et al. 2021

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“…Hence, the present study retrospectively analyzed the clinical characteristics and outcomes of subsequent chemotherapy in patients with advanced pancreatic cancer after the failure of initial chemotherapy in clinical practice. The median OS after the start of second-line chemotherapy was 6.4 months (95% CI, 4.5-8.6 months), similar to the recent retrospective reports of second-line chemotherapy for advanced pancreatic cancer in the real-world setting (5.2-8.1 months) [8][9][10]. Excellent PS, locally advanced disease, and normal CEA level at the time of second-line treatment initiation were associated with better OS.…”

Section: Discussionsupporting

confidence: 82%

“…Several studies have reported factors that can predict the survival outcomes of patients who undergo second-line chemotherapy [9,10,[14][15][16][17][18]. Among several clinical and biochemical variables, PS is one of the most common and important prognostic factors in patients receiving second-line chemotherapy [9,[14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

The clinical outcomes of second-line chemotherapy in patients with advanced pancreatic cancer: a retrospective study

Jung

Lee

2022

J Yeungnam Med Sci

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Background: Despite recent advances in first-line chemotherapy for advanced pancreatic cancer, standard treatment after the failure of initial chemotherapy has not been established. Hence, we aimed to retrospectively analyze the clinical characteristics and outcomes of second-line chemotherapy in patients with advanced pancreatic cancer. Methods: We reviewed the clinical data of patients with advanced pancreatic cancer who underwent palliative chemotherapy at Kosin University Gospel Hospital between January 2013 and October 2020. Results: Among 366 patients with advanced pancreatic cancer who had received palliative chemotherapy, 104 (28.4%) underwent at least one cycle of second-line chemotherapy. The median age of the patients at the time of initiating second-line treatment was 62 years (interquartile range, 57-62 years), and 58.7% (61 patients) of them were male. The common second-line chemotherapy regimens were 5-fluorouracil (FU) plus leucovorin, irinotecan, and oxaliplatin (33 patients, 31.7%); gemcitabine/nab-paclitaxel (29, 27.9%), gemcitabine ±erlotinib (13, 12.5%); and oxaliplatin and 5-FU/leucovorin (12, 11.5%). The median overall survival (OS) and progression-free survival were 6.4 months (95% confidence interval [CI], 4.5-8.6 months) and 4.5 months (95% CI, 2.7-6.3 months), respectively. In a multivariate analysis, poor performance status (PS) (hazard ratio [HR], 2.247; p= 0.021), metastatic disease (HR, 2.745; p= 0.011), and elevated carcinoembryonic antigen (CEA) levels (HR, 1.939; p = 0.030) at the beginning of second-line chemotherapy were associated with poor OS. Conclusion: The survival outcome of second-line chemotherapy for advanced pancreatic cancer remains poor. However, PS, disease extent (locally advanced or metastatic), and CEA level may help determine patients who could benefit from second-line treatment.

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“…Despite recent therapeutic advances, the prognosis of patients with metastatic pancreatic ductal adenocarcinoma (PDAC) remains poor. 1,2 Because .80% of patients with pancreatic cancer are diagnosed at an advanced stage, chemotherapy is the cornerstone of treatment. [3][4][5] However, international consensus on the most optimal firstand second-line palliative systemic treatment regimen is lacking.…”

Section: Introductionmentioning

confidence: 99%

First- and Second-Line Palliative Systemic Treatment Outcomes in a Real-World Metastatic Pancreatic Cancer Cohort

Pijnappel

Dijksterhuis

Geest

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: Metastatic pancreatic ductal adenocarcinoma (PDAC) is characterized by a poor survival rate, which can be improved by systemic treatment. Consensus on the most optimal first- and second-line palliative systemic treatment is lacking. The aim of this study was to describe the use of first- and second-line systemic treatment, overall survival (OS), and time to failure (TTF) of first- and second-line treatment in metastatic PDAC in a real-world setting. Patients and Methods: Patients with synchronous metastatic PDAC diagnosed between 2015 and 2018 who received systemic treatment were selected from the nationwide Netherlands Cancer Registry. OS and TTF were evaluated using Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard analyses. Results: The majority of 1,586 included patients received FOLFIRINOX (65%), followed by gemcitabine (18%), and gemcitabine + nab-paclitaxel (13%) in the first line. Median OS for first-line FOLFIRINOX, gemcitabine + nab-paclitaxel, and gemcitabine monotherapy was 6.6, 4.7, and 2.9 months, respectively. Compared to FOLFIRINOX, gemcitabine + nab-paclitaxel showed significantly inferior OS after adjustment for confounders (hazard ratio [HR], 1.20; 95% CI, 1.02–1.41), and gemcitabine monotherapy was independently associated with a shorter OS and TTF (HR, 1.98; 95% CI, 1.71–2.30 and HR, 2.31; 95% CI, 1.88–2.83, respectively). Of the 121 patients who received second-line systemic treatment, 33% received gemcitabine + nab-paclitaxel, followed by gemcitabine (31%) and FOLFIRINOX (10%). Conclusions: Based on population-based data in patients with metastatic PDAC, treatment predominantly consists of FOLFIRINOX in the first line and gemcitabine with or without nab-paclitaxel in the second line. FOLFIRINOX in the first line shows superior OS compared with gemcitabine with or without nab-paclitaxel.

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Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic Cancer

Cited by 17 publications

References 22 publications

Second-line palliative chemotherapy, survival, and prognostic factors in patients with advanced pancreatic cancer

Second-line palliative chemotherapy, survival, and prognostic factors in patients with advanced pancreatic cancer

The clinical outcomes of second-line chemotherapy in patients with advanced pancreatic cancer: a retrospective study

First- and Second-Line Palliative Systemic Treatment Outcomes in a Real-World Metastatic Pancreatic Cancer Cohort

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