Maier-Stocker Constantin, Bitzer Michael, Malek Nisar P, Plentz Ruben R
Department of Internal Medicine I, University Hospital , Tübingen , Germany.
Scand J Gastroenterol. 2014 Dec;49(12):1480-5. doi: 10.3109/00365521.2014.978816. Epub 2014 Nov 12.
Pancreatic ductal adenocarcinoma (PDAC) is the third most common tumor of the gastrointestinal tract. At the time of diagnosis, the majority of PDACs shows already metastasis and does not qualify for curative surgery. Therefore, palliative chemotherapy has a very high priority, but recommendations after failure of first-line chemotherapies are quite limited. The aim of our analysis was to evaluate the efficacy of different second-line treatments after pretreatment with gemcitabine (57.5%), gemcitabine + erlotinib (25%), and platinum-based chemotherapy (17.5%). We included all patients with advanced PDAC treated with second-line chemotherapy in our department between 2005 and 2012. A total of 22 patients were treated with XELOX, 8 patients with FOLFOX, 6 patients with gemcitabine (+/- erlotinib) and 4 patients with FOLFIRI. On average, the patients received 4.2 cycles (standard deviation [SD] SD: 3.5) over a period of 2.5 months (SD: 2.6). The median overall survival (OS) for all patients was 5.4 months, progression-free survival was 3.5 months, and a tumor control was achieved in 21% of all cases. Toxicity profile was acceptable between the second-line chemotherapies and there was no significant difference in the other investigated end points. Interestingly, there was also no effect of the first-line treatment and their duration for the OS of the second-line therapy. According to our findings, second-line chemotherapies in advanced PDAC are beneficial and should be offered to patients, but we did not detect any superiority of a specific drug combination. More prospective, randomized and larger studies are necessary to evaluate new strategies for second-line chemotherapies.
胰腺导管腺癌（PDAC）是胃肠道第三常见的肿瘤。在诊断时，大多数PDAC已出现转移，不符合根治性手术的条件。因此，姑息化疗具有非常高的优先级，但一线化疗失败后的治疗建议相当有限。我们分析的目的是评估在接受吉西他滨（57.5%）、吉西他滨+厄洛替尼（25%）和铂类化疗（17.5%）预处理后，不同二线治疗的疗效。我们纳入了2005年至2012年在我们科室接受二线化疗的所有晚期PDAC患者。共有22例患者接受了XELOX治疗，8例接受了FOLFOX治疗，6例接受了吉西他滨（±厄洛替尼）治疗，4例接受了FOLFIRI治疗。患者平均在2.5个月（标准差[SD]：2.6）内接受了4.2个周期（SD：3.5）的治疗。所有患者的中位总生存期（OS）为5.4个月，无进展生存期为3.5个月，21%的病例实现了肿瘤控制。二线化疗之间的毒性反应可接受，在其他研究的终点方面没有显著差异。有趣的是，一线治疗及其持续时间对二线治疗的OS也没有影响。根据我们的研究结果，晚期PDAC的二线化疗是有益的，应该提供给患者，但我们没有发现任何特定药物组合的优越性。需要更多前瞻性、随机和更大规模的研究来评估二线化疗的新策略。
