Nanoliposomal irinotecan with fluorouracil and folinic acid, FOLFIRINOX, and S-1 as second-line treatment for unresectable pancreatic cancer after gemcitabine/nab-paclitaxel

Abstract

This study aimed to compare second-line treatment outcomes for patients with unresectable pancreatic cancer previously treated with gemcitabine plus nab-paclitaxel (GnP) therapy. We conducted an integrated analysis of two retrospective studies included 318 patients receiving nanoliposomal irinotecan + 5-fluorouracil/folinic acid (NFF) (n = 102), S-1 (n = 57), or FOLFIRINOX (n = 14) as second-line treatment. Median overall survival (OS) in the NFF group was 9.08 months, significantly better than S-1 (4.90 months, P = 0.002). FOLFIRINOX had a median OS of 4.77 months, not statistically different from NFF. Subgroup analyses of OS indicated NFF was generally superior, however, a statistical interaction was observed between the treatment regimen in serum Alb < 3.5 g/dL (P = 0.042) and serum CRP ≥ 0.3 mg/dL (P = 0.006). Median progression-free survival (PFS) was 2.93 months for NFF, significantly better than S-1 (2.53 months, P = 0.024), while FOLFIRINOX had a comparable PFS (3.04 months, P = 0.948). Multivariate analysis identified the serum CRP, serum CA19-9, duration of first-line GnP therapy, and use (yes/no) of S-1 for second-line treatment as independent predictors for OS. This study concludes that second-line NFF therapy demonstrated a more favorable OS compared to S-1 therapy, however, it is still important to consider the patient background characteristics while selecting the most appropriate treatment.

Keywords: FOLFIRINOX; Nanoliposomal irinotecan; Pancreatic cancer; S-1; Second line.

Figure 1

Flow diagram of the study patients. GnP gemcitabine plus nab–paclitaxel, GEM gemcitabine, NFF nanoliposomal irinotecan with fluorouracil folinic acid.

Figure 2

Kaplan–Meier curves of OS (A) and PFS (B) in patients with unresectable pancreatic cancer receiving second-line chemotherapy. NFF nanoliposomal irinotecan with fluorouracil and folinic acid, OS overall survival, CI confidence interval, PFS progression-free survival.

Figure 3

Forest plot of overall survival in NFF vs. S-1 subgroups (A), and NFF vs. FOLFIRINOX subgroups (B). NFF nanoliposomal irinotecan with fluorouracil and folinic acid, HR hazard ratio, CI confidence interval, ECOG PS Eastern Cooperative Oncology Group performance status, CRP C–reactive protein, CA19-9 carbohydrate antigen 19-9, TTNT time to next treatment.