Viaud Juliette, Brac Clémence, Artru Pascal, Le Pabic Estelle, Leconte Bérengère, Bodère Anaïs, Pracht Marc, Le Sourd Samuel, Edeline Julien, Lièvre Astrid
Department of Hepato-Gastroenterology, CHU Rennes, Rennes, France.
Department of Medical Oncology, Centre Eugène Marquis, Rennes, France.
Dig Liver Dis. 2017 Jun;49(6):692-696. doi: 10.1016/j.dld.2017.02.007. Epub 2017 Feb 14.
Pancreatic adenocarcinoma (PA) is diagnosed in most cases at an advanced stage requiring chemotherapy. Folfirinox is the standard first-line treatment. After Folfirinox failure, gemcitabine alone is routinely used as second-line therapy without data supporting this attitude.
Determine the response rate and outcome of patients with advanced PA treated with gemcitabine after Folfirinox failure.
We retrospectively analyzed all consecutive patients treated with gemcitabine after Folfirinox failure for a locally advanced or metastatic PA between 2009 and 2015. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Response rate, control rate and tolerability were assessed.
96 patients were included (male, 51%; median age, 62; performance status (PS) 0-1, 47%). Median duration on gemcitabine was 2.1 months. The overall disease control rate was 40%. Median OS was 3.7 months (95%CI: 2.5-5.2) and median PFS was 2.1 months (95%CI: 2.0-2.6). Reasons for treatment discontinuation were mostly progression (51%). Age at diagnosis and PS were independently associated with OS in multivariate analysis (HR of 1.86; p=0.0055 and 2.42; p<0.0001 respectively). 34 patients experienced a grade 3 adverse event.
This study suggests that gemcitabine is not beneficial to all patients failing on Folfirinox first-line therapy and should be restricted to young patients with good PS.
大多数胰腺癌（PA）病例在确诊时已处于晚期，需要进行化疗。Folfirinox是标准的一线治疗方案。在Folfirinox治疗失败后，常规单独使用吉西他滨作为二线治疗，但并无数据支持这种做法。
确定Folfirinox治疗失败后接受吉西他滨治疗的晚期PA患者的缓解率和治疗结果。
我们回顾性分析了2009年至2015年间所有在Folfirinox治疗失败后接受吉西他滨治疗的局部晚期或转移性PA连续患者。采用Kaplan-Meier方法计算无进展生存期（PFS）和总生存期（OS）。评估缓解率、控制率和耐受性。
纳入96例患者（男性占51%；中位年龄62岁；体能状态（PS）为0 - 1者占47%）。吉西他滨治疗的中位持续时间为2.1个月。总体疾病控制率为40%。中位OS为3.7个月（95%CI：2.5 - 5.2），中位PFS为2.1个月（95%CI：2.0 - 2.6）。治疗中断的主要原因是疾病进展（51%）。在多因素分析中，诊断时年龄和PS与OS独立相关（HR分别为1.86；p = 0.0055和2.42；p < 0.0001）。34例患者发生3级不良事件。
本研究表明，吉西他滨对所有一线Folfirinox治疗失败的患者并无益处，应仅限于PS良好的年轻患者。
