Efficacy of Capecitabine Plus Oxaliplatin Combination Chemotherapy for Advanced Pancreatic Cancer after Failure of First-Line Gemcitabine-Based Therapy

Abstract

Background/aims: Second-line chemotherapy in patients with advanced pancreatic ductal adenocarcinoma (PDAC) that progresses following gemcitabine-based treatment has not been established. This study aimed to investigate the efficacy and safety of second-line combination chemotherapy with capecitabine and oxaliplatin (XELOX) in these patients.

Methods: Between August 2011 and May 2014, all patients who received at least one cycle of XELOX (capecitabine, 1,000 mg/m² twice daily for 14 days; oxaliplatin, 130 mg/m² on day 1 of a 3-week cycle) combination chemotherapy for unresectable or recurrent PDAC were retrospectively recruited. The response was evaluated every 9 weeks, and the tumor response rate, progression-free survival and overall survival, and adverse events were assessed.

Results: Sixty-two patients were included; seven patients (11.3%) had a partial tumor response, and 20 patients (32.3%) had stable disease. The median progression-free and overall survival were 88 days (range, 35.1 to 140.9 days) and 158 days (range, 118.1 to 197.9 days), respectively. Patients who remained stable longer with frontline therapy (≥120 days) exhibited significantly longer progression-free and overall survival. The most common grade 3 to 4 adverse events in patients were vomiting (8.1%) and anorexia (6.5%). There was one treatment-related mortality caused by severe neutropenia and typhlitis.

Conclusions: Second-line XELOX combination chemotherapy demonstrated an acceptable response and survival rate in patients with advanced PDAC who had failed gemcitabine-based chemotherapy.

Keywords: Capecitabine; Carcinoma, pancreatic ductal; Oxaliplatin; Salvage therapy; Treatment outcome.

Fig. 1

Kaplan-Meier estimation of progression-free survival. The median progression-free survival of patients was 88 days (range, 35.1 to 140.9 days). Patients who remained stable longer with frontline therapy (>120 days) had significantly longer progression-free survival (61 days [range, 53.9 to 68.1 days] in <120 days vs 116 days [range, 53.0 to 179.0 days] in ≥120 days, p=0.021). Solid line indicates patients who remained stable for more than 120 days, and broken line indicates patients who remained stable less than 120 days. Thick curve indicates overall patients. Dx., diagnosis.

Fig. 2

Kaplan-Meier estimation of overall survival. The median overall survival of patients was 158 days (range, 118.1 to 197.9 days). Patients who remained stable longer at frontline therapy (more than 120 days) had significantly longer overall survival (117 days [range, 62.7 to 171.3 days] in <120 days vs 177 days [range, 136.5 to 217.5 days] in ≥120 days, p=0.006). Solid line indicates patients who remained stable more than 120 days, and broken line indicates patients who remained stable less than 120 days. Thick curve indicates overall patients.