La Maddalena Clinic for Cancer, Department of Experimental Oncology and Clinical Applications, University of Palermo, Italy.
Am J Clin Oncol. 2010 Oct;33(5):461-4. doi: 10.1097/COC.0b013e3181b4e3b0.
Patients with advanced pancreatic cancer failing gemcitabine-based first-line chemotherapy are still in relatively good clinical conditions and may still require second-line chemotherapy, which is frequently administered in daily clinical practice given to without solid scientific support.
A retrospective survey was carried out including 40 patients with stage III or IV gemcitabine-refractory pancreatic carcinoma. Patients received standard FOLFIRI regimen biweekly until progression or unacceptable toxicity. Response evaluation criteria in solid tumors and National Cancer Institute common toxicity criteria were employed respectively for response and toxicity assessment.
Six partial responses (15%) and 14 stabilizations of disease (35%) were recorded for a tumor growth control rate of 50%. The median time to progression was 3.7 (range, 1-6.5 months), and median overall survival was 6 months (range, 2-8.2 months). A stabilization of performance status and a subjective improvement of cancer-related symptoms were recorded in 21 patients (52.5%). No correlation has been found between length of time to progression during first-line chemotherapy and length of that reported in the second-line setting or objective response. Grade 3-4 diarrhea and mucositis was observed in 15% and 10% of cases, respectively.
Data presented in this article demonstrate that the second-line FOLFIRI regimen are able to induce an objective response in a relatively small fraction of patients with gemcitabine-refractory adenocarcinoma of the pancreas. The use of second-line chemotherapy should be carefully proposed to patients with good performance status or those who had a good response to first-line therapy.
接受吉西他滨为基础的一线化疗失败的晚期胰腺癌患者仍处于相对良好的临床状态，可能仍需要二线化疗，而在日常临床实践中经常会在没有确凿科学依据的情况下使用二线化疗。
本研究回顾性分析了 40 例接受吉西他滨治疗后进展的Ⅲ或Ⅳ期胰腺癌患者。患者接受标准的 FOLFIRI 方案每两周一次，直至疾病进展或出现不可耐受的毒性。采用实体瘤反应评估标准和国家癌症研究所常见毒性标准分别评估疗效和毒性。
记录到 6 例部分缓解（15%）和 14 例疾病稳定（35%），肿瘤生长控制率为 50%。中位无进展生存期为 3.7 个月（范围 1-6.5 个月），中位总生存期为 6 个月（范围 2-8.2 个月）。21 例患者（52.5%）的体能状态稳定和癌症相关症状的主观改善。在一线化疗中无进展时间的长短与二线化疗中的无进展时间或客观反应之间没有相关性。3-4 级腹泻和黏膜炎的发生率分别为 15%和 10%。
本文的数据表明，二线 FOLFIRI 方案能够诱导相当一部分吉西他滨耐药的胰腺腺癌患者获得客观缓解。对于体能状态良好或对一线治疗有良好反应的患者，应慎重考虑使用二线化疗。
