Dadi Neelakanta, Stanley Melissa, Shahda Safi, O'Neil Bert H, Sehdev Amikar
Division of Hematology and Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, U.S.A.
Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, U.S.A.
Anticancer Res. 2017 Oct;37(10):5533-5539. doi: 10.21873/anticanres.11985.
Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy with median survival of 20% at 1 year. We conducted a retrospective study to assess the efficacy and tolerability of nab-paclitaxel (NP)-based second-line chemotherapy in metastatic PDAC.
The Indiana University Simon Cancer Center pancreatic cancer program was used to identify patients with metastatic PDAC who received any second-line chemotherapy. Demographic, clinical and outcomes data were collected by manual chart abstraction. Patients were divided into two groups: a NP-based treatment group and a non- NP-based treatment group. Overall (OS) and progression-free (PFS) survival were estimated using Kaplan-Meier method. Cox proportional hazards regression was used for multivariate analyses.
A total of 120 patients received second-line chemotherapy. There were 47 (39%) patients in the NP group and 73 (61%) in the non-NP group. As compared to the non-NP group, the NP group showed improved median PFS [2.8 vs. 2.1 months; hazard ratio (HR)=0.62, 95% confidence interval (CI)=0.38-1.02; p=0.06] and median OS (7.5 vs. 4.7 months; HR=0.67, 95% CI=0.45-1.00; p=0.05). Multivariate analyses adjusted for age showed a significantly improved PFS (adjusted HR=0.60, 95% CI=0.36-0.98; p=0.04) and a suggestion of improved OS (adjusted HR=0.67, 95% CI=0.44-1.01, p=0.05) in the NP group as compared to non-NP group. Serious adverse events were seen in 13.3% of patients in the non-NP group and 17.1% patients in the NP group.
In a single-institution retrospective cohort study, we report a significant improvement in the PFS and suggestion of improvement in the OS with NP-based second-line chemotherapy with an acceptable toxicity rate.
胰腺导管腺癌（PDAC）是一种致命的恶性肿瘤，1年中位生存率为20%。我们进行了一项回顾性研究，以评估基于纳米白蛋白结合型紫杉醇（NP）的二线化疗在转移性PDAC中的疗效和耐受性。
利用印第安纳大学西蒙癌症中心的胰腺癌项目，确定接受任何二线化疗的转移性PDAC患者。通过手工查阅病历收集人口统计学、临床和结局数据。患者分为两组：基于NP的治疗组和非基于NP的治疗组。采用Kaplan-Meier法估计总生存期（OS）和无进展生存期（PFS）。采用Cox比例风险回归进行多变量分析。
共有120例患者接受二线化疗。NP组47例（39%），非NP组73例（61%）。与非NP组相比，NP组的中位PFS有所改善[2.8个月对2.1个月；风险比（HR）=0.62，95%置信区间（CI）=0.38-1.02；p=0.06]，中位OS也有所改善（7.5个月对4.7个月；HR=0.67，95%CI=0.45-1.00；p=0.05）。校正年龄后的多变量分析显示，与非NP组相比，NP组的PFS显著改善（校正HR=0.60，95%CI=0.36-0.98；p=0.04），OS也有改善趋势（校正HR=0.67，95%CI=0.44-1.01，p=0.05）。非NP组13.3%的患者和NP组17.1%的患者出现严重不良事件。
在一项单机构回顾性队列研究中，我们报告基于NP的二线化疗可显著改善PFS，并提示可改善OS，且毒性率可接受。
