Oncology and Digestive Endoscopy Department of the CRLC Val d'Aurelle, 34000 Montpellier, France.
World J Gastroenterol. 2012 Mar 28;18(12):1357-64. doi: 10.3748/wjg.v18.i12.1357.
To investigate second-line chemotherapy in gemcitabine-pretreated patients with advanced or metastatic pancreatic cancer [(frequency, response, outcome, course of carbohydrate antigen 19-9 (CA 19-9)].
This retrospective study included all patients with advanced or metastatic pancreatic cancer (adenocarcinoma or carcinoma) treated with second-line chemotherapy in our center between 2000 and 2008. All patients received first-line chemotherapy with gemcitabine, and prior surgery or radiotherapy was permitted. We analyzed each chemotherapy protocol for second-line treatment, the number of cycles and the type of combination used. The primary endpoint was overall survival. Secondary endpoints included progression-free survival, response rate, grade 3-4 toxicity, dosage modifications and CA 19-9 course.
A total of eighty patients (38%) underwent a second-line therapy among 206 patients who had initially received first-line treatment with a gemcitabine-based regimen. Median number of cycles was 4 (range: 1-12) and the median duration of treatment was 2.6 mo (range: 0.3-7.4). The overall disease control rate was 40.0%. The median overall survival and progression-free survival from the start of second-line therapy were 5.8 (95% CI: 4.1-6.6) and 3.4 mo (95% CI: 2.4-4.2), respectively. Toxicity was generally acceptable. Median overall survival of patients with a CA 19-9 level declining by more than 20% was 10.3 mo (95% CI: 4.5-11.6) vs 5.2 mo (95% CI: 4.0-6.4) for others (P = 0.008).
A large proportion of patients could benefit from second-line therapy, and CA 19-9 allows efficient treatment monitoring both in first and second-line chemotherapy.
调查吉西他滨预处理后晚期或转移性胰腺癌患者的二线化疗[频率、反应、结果、碳水化合物抗原 19-9（CA 19-9）的变化]。
本回顾性研究纳入了 2000 年至 2008 年期间在我中心接受二线化疗的所有晚期或转移性胰腺癌（腺癌或癌）患者。所有患者均接受吉西他滨一线化疗，且允许有既往手术或放疗史。我们分析了二线治疗中每种化疗方案、所用周期数和联合用药类型。主要终点为总生存期。次要终点包括无进展生存期、反应率、3-4 级毒性、剂量调整和 CA 19-9 变化。
在 206 例初始接受吉西他滨为基础方案一线治疗的患者中，共有 80 例（38%）患者接受了二线治疗。中位周期数为 4 个（范围：1-12），中位治疗时间为 2.6 个月（范围：0.3-7.4）。总疾病控制率为 40.0%。二线治疗开始后中位总生存期和无进展生存期分别为 5.8 个月（95%CI：4.1-6.6）和 3.4 个月（95%CI：2.4-4.2）。毒性一般可耐受。CA 19-9 水平下降超过 20%的患者中位总生存期为 10.3 个月（95%CI：4.5-11.6），而其他患者为 5.2 个月（95%CI：4.0-6.4）（P = 0.008）。
很大一部分患者可从二线治疗中获益，且 CA 19-9 可在一线和二线化疗中有效监测治疗。
