Efficacy of second-line treatment for gemcitabine-refractory unresectable pancreatic cancer in a real-world setting.
This study aimed to compare the benefits and identify the best second-line treatment regimen for gemcitabine-refractory unresectable pancreatic cancers.
This retrospective analysis included 144 patients with unresectable pancreatic cancer who underwent a gemcitabine-based regimen as the first-line treatment. 57, 37, and 50 patients received oxaliplatin-, irinotecan-based, and modified FOLFIRINOX (mFFX) regimens, respectively. The primary endpoint of this study was progression-free survival (PFS) and the secondary endpoints were overall survival (OS), response rate, and treatment-related toxicity.
There were no significant differences in median PFS (mPFS) (4.6 months vs. 2.9 months, P = 0.627, HR = 1.128, 95%CI 0.693-1.836) and median OS (mOS) (6.5 months vs. 10.2 months, P = 0.108, HR = 0.664, 95%CI 0.392-1.125) between irinotecan- and oxaliplatin-based groups. The mOS was significantly longer in the mFFX group than in the Iri/Oxa group (pooled the irinotecan- and oxaliplatin-based groups) (10.7 months vs. 8.8 months, P = 0.035, HR = 1.560, 95%CI 1.037-2.347), whereas no statistical difference was observed in mPFS between the two groups (4.4 months vs. 4.2 months, P = 0.222, HR = 1.247, 95%CI 0.866-1.797). However, after propensity score matching adjustment, no significant differences were found in mPFS (3.5 months vs. 4.2 months, P = 0.290, HR = 0.763, 95%CI 0.448-1.297) and mOS (8.5 months vs. 12.4 months, P = 0.464, HR = 1.262, 95%CI 0.673-2.367) between mFFX and Iri/Oxa groups. Survival analysis by performance status showed that patients with good performance status lived longer than those with poor performance status (10.8 months vs. 7.7 months, P = 0.000, HR = 2.194, 95%CI 1.408-3.420), suggesting that patient performance status, rather than the treatment regimen, was the primary factor affecting overall survival during second-line treatment.
In the second-line treatment of pancreatic cancer, the efficacy of common treatment regimens is not significantly different, while a good performance status is the key factor influencing survival. Thus, it is recommended that supportive care be enhanced concurrently with systemic therapy in patients with pancreatic cancer.
This retrospective analysis included 144 patients with unresectable pancreatic cancer who underwent a gemcitabine-based regimen as the first-line treatment. 57, 37, and 50 patients received oxaliplatin-, irinotecan-based, and modified FOLFIRINOX (mFFX) regimens, respectively. The primary endpoint of this study was progression-free survival (PFS) and the secondary endpoints were overall survival (OS), response rate, and treatment-related toxicity.
There were no significant differences in median PFS (mPFS) (4.6 months vs. 2.9 months, P = 0.627, HR = 1.128, 95%CI 0.693-1.836) and median OS (mOS) (6.5 months vs. 10.2 months, P = 0.108, HR = 0.664, 95%CI 0.392-1.125) between irinotecan- and oxaliplatin-based groups. The mOS was significantly longer in the mFFX group than in the Iri/Oxa group (pooled the irinotecan- and oxaliplatin-based groups) (10.7 months vs. 8.8 months, P = 0.035, HR = 1.560, 95%CI 1.037-2.347), whereas no statistical difference was observed in mPFS between the two groups (4.4 months vs. 4.2 months, P = 0.222, HR = 1.247, 95%CI 0.866-1.797). However, after propensity score matching adjustment, no significant differences were found in mPFS (3.5 months vs. 4.2 months, P = 0.290, HR = 0.763, 95%CI 0.448-1.297) and mOS (8.5 months vs. 12.4 months, P = 0.464, HR = 1.262, 95%CI 0.673-2.367) between mFFX and Iri/Oxa groups. Survival analysis by performance status showed that patients with good performance status lived longer than those with poor performance status (10.8 months vs. 7.7 months, P = 0.000, HR = 2.194, 95%CI 1.408-3.420), suggesting that patient performance status, rather than the treatment regimen, was the primary factor affecting overall survival during second-line treatment.
In the second-line treatment of pancreatic cancer, the efficacy of common treatment regimens is not significantly different, while a good performance status is the key factor influencing survival. Thus, it is recommended that supportive care be enhanced concurrently with systemic therapy in patients with pancreatic cancer.
Authors
Wang Wang, Lv Lv, Xu Xu, Wu Wu, Wu Wu, Gao Gao, Wei Wei, Xiao Xiao, Tu Tu, Jiang Jiang
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