Second-line chemotherapy for the treatment of metastatic pancreatic cancer after first-line gemcitabine-based chemotherapy: a network meta-analysis

Citterio, Chiara; Baccini, Michela; Orlandi, Elena; Nunzio, Camilla Di; Cavanna, Luigi

doi:10.18632/oncotarget.25639

Cited by 14 publications

(13 citation statements)

References 27 publications

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“…In particular, Sonbol et al [ 51 ] collected randomized controlled trials comparing FP monotherapy vs FPOX or FPIRI and showed that FPOX or FPIRI improved PFS compared with single-agent FP, but only FPIRI reported an OS advantage. Similarly, in the network meta-analysis by Citterio et al [ 52 ] and the meta-analysis by Catalano et al [ 40 ], FPIRI seemed superior to FPOX in terms of OS. Conversely, in the systematic review of 24 studies by Petrelli et al [ 53 ], FPOX and FPIRI were associated with a similar efficacy, with a pooled ORR, DCR, PFS and OS of 11%, 37.9%, 2.87 mo and 5.48 mo, respectively.…”

Section: Current Clinical Practice In Second Line Mpdacmentioning

confidence: 80%

Pancreatic adenocarcinoma: Beyond first line, where are we?

Cherri¹,

Noventa²,

Zaniboni³

2021

WJG

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Pancreatic cancer is considered one of the most aggressive cancers, with an increasing incidence in recent years. To date, chemotherapy is still the standard of care for advanced metastatic disease, unfortunately providing only a slight advantage in terms of survival. The molecular and cellular characteristics of pancreatic cancer cells, as well as the cells that characterize the pancreatic tumour microenvironment, are the basis of the mechanisms of resistance to treatment. After progression during first-line treatment, few patients are eligible for second-line treatment due to the loss of performance status. To date, a clear survival advantage has not yet been demonstrated for second-line chemotherapy. Precision medicine could be the key to increasing responses to cancer treatment and finally impacting survival in this difficult-to-treat disease. In this review, we analyze current recommendations in the second-line setting and potential future prospects.

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Section: Current Clinical Practice In Second Line Mpdacmentioning

confidence: 80%

Pancreatic adenocarcinoma: Beyond first line, where are we?

Cherri¹,

Noventa²,

Zaniboni³

2021

WJG

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“…Certain treatments, including 5-FU monotherapy, presented significantly decreased survival compared with Gem monotherapy and have demonstrated the effectiveness of Gem as a first-line chemotherapy for APC. Although certain trials examining combination therapies demonstrated improved objective response rates, the treatments failed to achieved improvement in all three of the most common outcomes measured; Median survival, PFS and the objective response rate (35–39). The present network meta-analysis of patients with unresectable pancreatic cancer suggested that the current median survival for patients treated with Gem was >6 months, and the objective response rate for Gem ranged between 4.4 and 17.3% (40).…”

Section: Discussionmentioning

confidence: 99%

Meta‑analysis of current chemotherapy regimens in advanced pancreatic cancer to prolong survival and reduce treatment‑associated toxicities

Chen

et al. 2018

Mol Med Report

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Unresectable advanced pancreatic cancer (APC) is a highly lethal malignancy. Although numerous chemotherapeutic regimens are available, evidence regarding the survival extension, the life quality improvement, the associated risks and occurrence rates of adverse effects, is required. The effects of 19 chemotherapy regimens on survival and treatment-associated toxicities in the context of APC treatment were comparatively assessed. A total of 23 randomized controlled trials were included in this network meta-analysis. For overall survival, five regimens, Gemcitabine (Gem)+radiotherapy (Radio), Gem+cisplatin (Cis), Gem+erlotinib (Erl)+bevacizumab (Bev), Gem+capecitabine (Cap)+Erl, and Gem+exatecan, were the most effective treatments, according to their respective high surface under the cumulative ranking (SUCRA) probabilities. Regarding the progression-free survival, five regimens, including Gem+Radio, Gem+Erl+Bev, Gem+Cis, Gem+Cap+Erl and Gem+pemetrexed, were the most effective treatments based on their SUCRA probabilities. Each regimen exhibited advantages and disadvantages, and 14 common treatment-associated toxicities were present in different proportions. The three principal toxic effects included haematological, gastrointestinal and constitutional symptoms. To improve survival, chemotherapy regimens with high SUCRA probabilities require prioritizing. Although treatment-associated toxicities are unavoidable, the regimens presented toxicities in distinct proportions. Therefore, clinicians should assess the disease status of the patients, and balance the benefits and risks of the selected treatment.

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“…These patients might therefore have experienced lower response rates and worse survival outcomes that could potentially have an adverse effect on the study results. 29,30…”

Section: Discussionmentioning

confidence: 99%

Gemcitabine Plus Nanoparticle Albumin-bound Paclitaxel for Patients with Inoperable Pancreatic Cancer: Experience at a Single Oncology Centre

Lam

Cheung

et al. 2020

Hong Kong Journal of Radiology

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Objective: To review the outcomes of gemcitabine plus nanoparticle albumin-bound (nab)-paclitaxel for patients with inoperable pancreatic cancer. Methods: The data of patients treated with this regimen at a single oncology centre in Hong Kong between December 2014 and December 2017 were retrospectively reviewed. Patient data assessed included serial tumour markers (carbohydrate antigen 19-9 and/or carcinoembryonic antigen) and ultrasound, computed tomography, or positron emission tomography-computed tomography scans. The primary objective was to evaluate progression-free and overall survival. The secondary objective was to evaluate the rate of treatment-related toxicities. All adverse events were graded with the Common Terminology Criteria for Adverse Events version 5. Results: The data of a total of 35 patients were analysed. The median age was 61 years and the majority (77%) had stage IV disease. Histological diagnosis was available in 74% of patients. The median number of cycles received was three. A total of 31% of patients required dose reduction of nab-paclitaxel. Median progression-free survival was 4.9 months (95% confidence interval [CI] = 3.4-6.4), and median overall survival was 7.5 months (95% CI = 5.6-9.4). Overall, 51% of patients received second-line or third-line chemotherapy following disease progression. Grade ≥3 neutropoenia occurred in 29% of patients and febrile neutropoenia in 6%. Grade ≥3 peripheral neuropathy occurred in 9% of patients. Conclusion: Gemcitabine plus nab-paclitaxel doublet chemotherapy is an effective and safe treatment for inoperable pancreatic cancer. Data from our centre are comparable to literature published to date. However, prognosis remains poor for this disease.

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Second-line chemotherapy for the treatment of metastatic pancreatic cancer after first-line gemcitabine-based chemotherapy: a network meta-analysis

Cited by 14 publications

References 27 publications

Pancreatic adenocarcinoma: Beyond first line, where are we?

Pancreatic adenocarcinoma: Beyond first line, where are we?

Meta‑analysis of current chemotherapy regimens in advanced pancreatic cancer to prolong survival and reduce treatment‑associated toxicities

Gemcitabine Plus Nanoparticle Albumin-bound Paclitaxel for Patients with Inoperable Pancreatic Cancer: Experience at a Single Oncology Centre

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