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. 2012 Mar 28;18(12):1357-64.
doi: 10.3748/wjg.v18.i12.1357.

Second-line therapy for gemcitabine-pretreated advanced or metastatic pancreatic cancer

Romain Altwegg  1 , Marc Ychou, Vanessa Guillaumon, Simon Thezenas, Pierre Senesse, Nicolas Flori, Thibault Mazard, Ludovic Caillo, Stéphanie Faure, Emmanuelle Samalin, Eric Assenat
Affiliations

Second-line therapy for gemcitabine-pretreated advanced or metastatic pancreatic cancer

Romain Altwegg et al. World J Gastroenterol. .

Abstract

Aim: To investigate second-line chemotherapy in gemcitabine-pretreated patients with advanced or metastatic pancreatic cancer [(frequency, response, outcome, course of carbohydrate antigen 19-9 (CA 19-9)].

Methods: This retrospective study included all patients with advanced or metastatic pancreatic cancer (adenocarcinoma or carcinoma) treated with second-line chemotherapy in our center between 2000 and 2008. All patients received first-line chemotherapy with gemcitabine, and prior surgery or radiotherapy was permitted. We analyzed each chemotherapy protocol for second-line treatment, the number of cycles and the type of combination used. The primary endpoint was overall survival. Secondary endpoints included progression-free survival, response rate, grade 3-4 toxicity, dosage modifications and CA 19-9 course.

Results: A total of eighty patients (38%) underwent a second-line therapy among 206 patients who had initially received first-line treatment with a gemcitabine-based regimen. Median number of cycles was 4 (range: 1-12) and the median duration of treatment was 2.6 mo (range: 0.3-7.4). The overall disease control rate was 40.0%. The median overall survival and progression-free survival from the start of second-line therapy were 5.8 (95% CI: 4.1-6.6) and 3.4 mo (95% CI: 2.4-4.2), respectively. Toxicity was generally acceptable. Median overall survival of patients with a CA 19-9 level declining by more than 20% was 10.3 mo (95% CI: 4.5-11.6) vs 5.2 mo (95% CI: 4.0-6.4) for others (P = 0.008).

Conclusion: A large proportion of patients could benefit from second-line therapy, and CA 19-9 allows efficient treatment monitoring both in first and second-line chemotherapy.

Keywords: Carbohydrate antigen 19-9; Chemotherapy; Gemcitabine; Pancreatic cancer; Second-line.

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Figures

Figure 1
Figure 1
Survival from the start of second-line therapy. A: Overall survival; B: Progression-free survival.
Figure 2
Figure 2
Overall survival and carbohydrate antigen 19-9 evolution in second line. A: Overall surviva; B: Progression-free survival. Ev. Ca 19-9: Course of carbohydrate antigen 19-9.
See this image and copyright information in PMC

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