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. 2024 Feb 26;24(1):272.
doi: 10.1186/s12885-024-12016-z.

Pancreatic adenocarcinoma third line systemic treatments: a retrospective cohort study

A Gueiderikh  1   2 , A Tarabay  1 , M Abdelouahab  3 , C Smolenschi  1   4 , M L Tanguy  3 , M Valery  1 , D Malka  5 , T Pudlarz  1 , A Fuerea  1 , V Boige  1 , A Hollebecque  1   4 , M Ducreux  1   2 , A Boilève  6   7
Affiliations

Pancreatic adenocarcinoma third line systemic treatments: a retrospective cohort study

A Gueiderikh et al. BMC Cancer. .

Abstract

Background: Chemotherapy for metastatic pancreatic adenocarcinoma (PDAC) primarily relies on FOLFIRINOX (LV5FU- irinotecan - Oxaliplatine) and Gemcitabine - Nab-Paclitaxel in the first-line setting. However, second-lines remain less well-defined and there is limited data regarding third-line treatments. The objective of our study was to determine the proportion of patients advancing to third line chemotherapy, to outline the various third-line chemotherapy regimens used in routine practice and to evaluate their respective efficacy.

Methods: A retrospective single-center cohort from 2010-2022 compiled baseline characteristics, treatment outcomes and survival of PDAC patients who received at least one chemotherapy line in a French tertiary-center. Overall survivals (OS) were analyzed using a Cox multivariable model.

Results: In total, 676 patients were included, with a median follow-up time of 69.4 months, (Interquartile Range (IQR) = 72.1). Of these, 251 patients (37%) that proceeded to 3rd-line chemotherapy. The median PFS in 3rd line was 2.03 months, [CI95%: 1.83, 2.36]. The median 3rd line overall survival was 5.5 months, [CI95%: 4.8, 6.3]. In multivariable analysis erlotinib-based chemotherapy was found to be deleterious (HR=2.38, [CI95%: 1.30, 4.34], p=0.005) compared to fluoropyrimidine-based chemotherapy in terms of 3rd line overall survival while gemcitabine monotherapy showed a tendency towards negative outcomes. First and 2nd line chemotherapies sequence didn't influence 3rd line outcome.

Conclusion: In our cohort, one-third of treated patients proceeded to 3rd line chemotherapy resulting in a 5.5 months median 3rd line OS, consistent with treatments at advanced stage. Our results argue against the use of erlotinib and gemcitabine monotherapy.

Keywords: Erlotinib; FOLFIRINOX; Gemcitabine; Pancreatic adenocarcinoma; mPDAC.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig 1
Fig 1
A Flowchart of the study, B Third line Progression free survival, C Third line Overall Survival
Fig 2
Fig 2
A Chemotherapy type evolution over years, B Survival probability of different chemotherapy groups and associated median survival using a Kaplan Meier analysis
See this image and copyright information in PMC

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