Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Cancer Res Treat. 2020 Jan;52(1):254-262. doi: 10.4143/crt.2019.190. Epub 2019 Jul 9.
Since the introduction of nab-paclitaxel plus gemcitabine (nab-P+GEM) as first-line (1L) treatment for metastatic pancreatic adenocarcinoma (mPDAC), optimal second-line (2L) chemotherapy after progression is unclear. We assessed clinical outcomes of 2L chemotherapy for disease that progressed on 1L nab-P+GEM.
Among the 203 patients previously treated with 1L nab-P+GEM for mPDAC at Asan Medical Center, between February and December 2016, records of 120 patients receiving 2L chemotherapy after progression on nab-P+GEM were retrospectively reviewed. The response rate and survival were evaluated along with analysis of prognostic factors.
Fluoropyrimidine-oxaliplatin doublets (FOLFOX or XELOX) were used in 78 patients (65.0%), fluoropyrimidine monotherapy in 37 (30.8%), and liposomal irinotecan plus fluorouracil in two (1.7%). The median progression-free survival (PFS) and overall survival (OS) were 3.29 months and 7.33 months from the start of 2L therapy. Fluoropyrimidine-oxaliplatin regimens and fluoropyrimidine monotherapy did not yield significantly different median PFS (2.89 months vs. 3.81 months, p=0.40) or OS (7.04 months vs. 7.43 months, p=0.86). A high neutrophil-lymphocyte ratio (> 2.2) and a short time to progression with 1L nab-P+GEM (< 6.4 months) were independent prognostic factors of poor OS with 2L therapy.
2L fluoropyrimidine-oxaliplatin doublets and fluoropyrimidine monotherapy after failure of 1L nab-P+GEM had modest efficacy, with no differences in treatment outcomes between them. Further investigation is warranted for the optimal 2L chemo-regimens and sequencing of systemic chemotherapy for patients with mPDAC.
自纳武利尤单抗联合吉西他滨（nab-P+GEM）作为转移性胰腺导管腺癌（mPDAC）一线治疗药物问世以来，对于进展后的最佳二线（2L）化疗方案仍不明确。我们评估了在一线 nab-P+GEM 治疗进展后使用二线化疗治疗疾病的临床结果。
在 2016 年 2 月至 12 月期间，在 Asan 医疗中心接受过一线 nab-P+GEM 治疗的 203 例 mPDAC 患者中，回顾性分析了 120 例在 nab-P+GEM 治疗进展后接受二线化疗的患者记录。评估了反应率和生存情况，并分析了预后因素。
氟嘧啶奥沙利铂二联（FOLFOX 或 XELOX）在 78 例患者（65.0%）中使用，氟嘧啶单药在 37 例患者（30.8%）中使用，脂质体伊立替康联合氟尿嘧啶在 2 例患者（1.7%）中使用。二线治疗开始后中位无进展生存期（PFS）和总生存期（OS）分别为 3.29 个月和 7.33 个月。氟嘧啶奥沙利铂方案和氟嘧啶单药治疗的中位 PFS（2.89 个月 vs. 3.81 个月，p=0.40）或 OS（7.04 个月 vs. 7.43 个月，p=0.86）无显著差异。高中性粒细胞-淋巴细胞比值（>2.2）和一线 nab-P+GEM 进展时间较短（<6.4 个月）是二线治疗 OS 较差的独立预后因素。
一线 nab-P+GEM 治疗失败后使用氟嘧啶奥沙利铂二联和氟嘧啶单药治疗疗效适中，两者之间无治疗结果差异。需要进一步研究 mPDAC 患者的最佳二线化疗方案和系统化疗的序贯治疗。
