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Retrospective analysis of second-line chemotherapy after Folfirinox failure in advanced pancreatic cancer
Despite the use of intensive chemotherapy regimens, most patients with advanced pancreatic cancer rapidly progress after the start of first-line therapy. A lot of them remain in good performance status at the time of progression. There is no standard of care for second-line treatment after progression on FOLFIRINOX.
We retrospectively analyzed the data of patients(pts) with advanced pancreatic cancer who progressed after the first-line mFOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 150 mg/m2, leucovorin 400 mg/m2, 5FU 2400 mg/m2 for 46h) and received GemNab (gemcitabine 1000 mg/m2 1,8,15d, nab-paclitaxel 125mg/m2 1,8,15d) or gemcitabine monotherapy (Gem) 1000mg/m2 1,8,15d) as second line in 3 centers.
Between 2010 and 2022 102 patients were included in the analysis. The median age in gemcitabine group was 58 years (range 28-78) and 60 years in GemNab (range 38-86). 46 pts were treated with GemNab, 56 patients with gemcitabine. The majority of patients had ECOG PS 0-1 in each group, a patient had ECOG 2 in GemNab group and 2 pts in gemcitabine group. 30 pts (55%) had distant metastases in gemcitabine group and 27 pts (59%) in GemNab group. The median overall survival (OS) in GemNab and Gem groups were 15 m.o and 12 m.o (p=0.672), respectively. The median progression free survival (PFS) were significantly better in GemNab group: 5 m.о vs 3 m.o in gemcitabine group (p=0.038) Toxicity was different with less nausea, neutropenia, neurotoxicity with gemcitabine monotherapy.
GemNab appeared to be more effective than gemcitabine monotherapy in patients with advanced pancreatic cancer as a second-line treatment after progression on mFOLFIRINOX and should be considered as a standard of care.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.
