Miwa Keisuke, Kawasaki Reina, Shimokawa Mototsugu, Otsuka Taiga, Tanaka Toshimitsu, Fukahori Masaru, Shibuki Taro, Nakazawa Junichi, Arima Shiho, Koga Futa, Ueda Yujiro, Kubotsu Yoshihito, Shimokawa Hozumi, Takeshita Shigeyuki, Nishikawa Kazuo, Komori Azusa, Otsu Satoshi, Hosokawa Ayumu, Sakai Tatsunori, Oda Hisanobu, Kawahira Machiko, Arita Shuji, Honda Takuya, Taguchi Hiroki, Tsuneyoshi Kengo, Fujita Toshihiro, Sakae Takahiro, Kawaguchi Yasunori, Shirakawa Tsuyoshi, Mizuta Toshihiko, Mitsugi Kenji
Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Fukuoka, Japan.
Division of Integrative Medical Oncology, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
Front Oncol. 2025 Jul 17;15:1626689. doi: 10.3389/fonc.2025.1626689. eCollection 2025.
The significance of third-line chemotherapy (CTx) in unresectable pancreatic cancer (UPC) remains unclear. This study evaluated the therapeutic impact of third-line CTx after nanoliposomal irinotecan and fluorouracil combined with folinic acid (nal-IRI + 5-FU/LV) therapy as second-line CTx for UPC.
Between June 2020 and May 2021, 104 patients who received nal-IRI + 5-FU/LV therapy as second-line CTx were retrospectively analyzed for post-discontinuation survival (PDS) and overall survival (OS). Comparisons were made between patients transitioning to third-line CTx and those receiving best supportive care (BSC), using a Cox proportional hazards model adjusted for patient background.
Of the cohort, 34 patients received third-line CTx, whereas 61 transitioned to BSC. The median OS from first-line CTx in the third-line CTx group was 18.0 months, with a median OS of 9.7 months from second-line CTx. Adjusted median PDS following second-line CTx was 6.5 months for the third-line CTx group compared to 2.3 months for the BSC group (adjusted hazard ratio 0.16; 95% confidence interval 0.08-0.32; P < 0.01).
Third-line CTx should be actively considered for patients with UPC, as the approach may significantly extend survival in those who can tolerate the treatment.
三线化疗（CTx）在不可切除胰腺癌（UPC）中的意义尚不清楚。本研究评估了纳米脂质体伊立替康和氟尿嘧啶联合亚叶酸（nal-IRI + 5-FU/LV）作为UPC二线CTx治疗后三线CTx的治疗效果。
回顾性分析2020年6月至2021年5月期间接受nal-IRI + 5-FU/LV作为二线CTx治疗的104例患者的停药后生存期（PDS）和总生存期（OS）。使用针对患者背景进行调整的Cox比例风险模型，对转为三线CTx的患者和接受最佳支持治疗（BSC）的患者进行比较。
该队列中，34例患者接受了三线CTx，而61例转为BSC。三线CTx组从一线CTx开始的中位OS为18.0个月，从二线CTx开始的中位OS为9.7个月。二线CTx后，三线CTx组调整后的中位PDS为6.5个月，而BSC组为2.3个月（调整后的风险比0.16；95%置信区间0.08 - 0.32；P < 0.01）。
对于UPC患者应积极考虑三线CTx，因为这种方法可能会显著延长能够耐受治疗的患者的生存期。
