Synergistic effect of additional anlotinib and immunotherapy as second‐line or later‐line treatment in pancreatic cancer: A retrospective cohort study

Abstract

BackgroundPancreatic ductal adenocarcinoma (PDAC) is in urgent need of a second‐line or later‐line treatment strategy. We aimed to analyze the efficacy and safety of additional anlotinib, specifically anlotinib in combination with immunotherapy, in patients with PDAC who have failed first‐line therapy.MethodsPatients with pathological diagnosis of PDAC were additionally treated with anlotinib, and some patients were treated with anti‐PD‐1 agents at the same time, which could be retrospectively analyzed. The efficacy and safety of additional anlotinib were evaluated.ResultsA total of 23 patients were included. In patients treated with additional anlotinib, the overall median progression‐free survival (PFS) was 1.8 months and the median overall survival (OS) was 6.3 months, regardless of anti‐PD‐1 agents. Among patients receiving additional anlotinib in combination with anti‐PD‐1 agents, median PFS and OS were 1.8 and 6.5 months, respectively. Adverse events (AEs) were observed in 16 patients (69.6%). In patients treated with additional anlotinib, the majority of AEs were grade 1–3. Univariate analysis revealed that patients with baseline red blood cell distribution width (RDW) <14% treated with additional anlotinib plus anti‐PD‐1 agents had significantly longer OS than patients with baseline RDW ≥14% (p = 0.025). Patients with additional anlotinib plus anti‐PD‐1 agents as second‐line therapy had a longer OS than those treated as later‐line therapy (p = 0.012). Multivariate analysis showed that baseline RDW was the only independent risk factor for OS (p = 0.042).ConclusionThe combination of anlotinib and immunotherapy represents an effective add‐on therapy with tolerable AEs as second‐ or later‐line therapy in patients with PDAC, particularly in patients with baseline RDW <14%.