Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Jun 4;30(6):oyaf125.
doi: 10.1093/oncolo/oyaf125.

Predictive and prognostic factors of efficacy of third-line chemotherapy in patients with unresectable pancreatic cancer: a cohort-based study

Camille Evrard  1   2 , Antoine Pelras  3 , Simon Rivet  4 , Jean-Baptiste Bachet  5 , Olivier Dubreuil  5 , Anne-Laure Pointet  6 , Julien Taieb  6 , Widad Lahlou  6 , Alix Portal  6 , Céline Lepère  6 , Thierry Lecomte  7 , Romain Chautard  7 , Nicolas Williet  8 , Jean-Marc Phelip  8 , Clélia Coutzac  9 , Emilie Soularue  10 , Lysiane Marthey  10 , Raëf Abdallah  10 , Anne Thirot Bidault  11 , Pascal Artru  12 , Jérome Desrame  12 , Bertrand Le Roy  13 , Marine Jary  13 , Pascal Hammel  14 , Isabelle Trouilloud  15 , Nelson Lourenco  16 , Vincent Hautefeuille  17 , Laëtitia Dahan  18 , Simon Pernot  19 , Dominique Béchade  19 , Astrid Pozet  20 , Franck Bonnetain  20 , Christophe Locher  21 , Johann Dréanic  22 , Romain Coriat  23 , Bélinda Tchoundjeu  24 , Yohann Foucher  3   25 , David Tougeron  2   4
Affiliations
Multicenter Study

Predictive and prognostic factors of efficacy of third-line chemotherapy in patients with unresectable pancreatic cancer: a cohort-based study

Camille Evrard et al. Oncologist. .

Abstract

Background: Advanced pancreatic ductal adenocarcinoma (aPDAC) has a poor prognosis with median overall survival (OS) of about 12 months. It is therefore important to explore factors that predict the efficacy of third-line chemotherapy (L3) to identify patients who may benefit from this controversial treatment.

Methods: We conducted a multicenter retrospective cohort-based study of 202 French patients treated for aPDAC who received at least three treatment lines from January 2011 to March 2022. We used penalized Cox regressions to predict progression-free survival (PFS) and OS in patients on L3.

Results: Median age at the start of L3 was 64.3 years old and 63.5% had an Eastern Cooperative Oncology Group Performance Status (ECOG-PS) of 0 or 1. The most frequent regimens for L3 were FOLFIRI (25.2% of patients). Median PFS was 2.2 months, while median OS was 4.2 months. In multivariate models, we identified the following predictors of both PFS and OS: age, sex, surgery for the primary tumor, FOLFIRINOX as the first-line therapy, duration of first and second-line treatments, and for L3: ECOG-PS level, peritoneum, liver and/or lung metastasis and depletion of therapeutic resources. The model incorporating these factors provided acceptable discrimination between event and event-free patients at 6 months post-L3 (area under the ROC curve of 0.83 for PFS and 0.73 for OS).

Conclusion: The characteristics of patients and their aPDAC are readily available in clinical practice and were able to predict survival with L3. The online calculator we propose here could help physicians determine whether L3 chemotherapy would be beneficial.

Keywords: cohort; pancreatic cancer; predictive factors; third-line chemotherapy.

PubMed Disclaimer

Conflict of interest statement

C.E.; A.Pe; S.R.; O.D.; A.l.P.; W.L.; A.Po; T.L.; R.C.; N.W.; J.M.P.; E.S.; L.M.; R.A.; A.T.B.; P.A.; J.D.; B.L.R.; P.H.; I.T.; N.L.; V.H.; L.D.; D.B.; A.sP.; F.B.*; C.L.; J.D.; R.C.; B.T.; Y.F. and D.T.: declare no conflict of interest. J.B.B.: has received personal fees from Abbvie, Amgen, Bristol Myers Squibb, GSK, Leo Pharma, Merck Serono, Merck Sharp & Dohme, Pierre Fabre, Servier, Takeda, and non-financial support from Amgen, Merck Serono, and Roche, outside the submitted work. J.T. has received honoraria as a speaker and/or in an advisory role from AMGEN, Astellas, Astra Zeneca, Boehringer, BMS, Brenus Pharma, Bicara therapeutic, Oxford biotherapeutics, PROSKOPE, Merck KGaA, MSD, Novartis, ONO pharmaceuticals, Pierre Fabre, Natera, Sanofi, Servier and Takeda. C.L.: congress invitations by Amgen, Servier, Leo Pharma, Roche, Mundipharma, Pierre Fabre, Accord Healthcare France. C.C.: Amgen, Astra-Zeneca, Bristol-Myers Squib, Daiichi Sankyo, Jazz Pharmaceuticals, Merck Serono, Merck Sharp and Dohme, Mundipharma, Pierre Fabre, Roche, Servier. M.J.: consulting/advisory relationship for Amgen, Bristol-Myers Squibb, Incyte Biosciences, M.S.D., Pierre Fabre, Roche, Servier, Astra Zeneca. S.P.: consulting: Amgen, Pierre Fabre, BMS, Astra-Zeneca, Takeda, MSD, Merck. *dead.

Figures

Figure 1.
Figure 1.
Sankey diagram of treatment sequence, different lines of treatment are shown on the × axis and number of patients on the y axis. Abbreviations: 5 FU:5 fluorouracil; Gmz: gemcitabine
Figure 2.
Figure 2.
Survival from the start of third-line therapy. (A) Progression-free survival in third-line therapy. (B) Overall survival in third-line therapy. (C) Survival with third-line therapy according chemotherapy regimens. Abbreviations: OS: overall survival; PFS: progression-free survival; PFS3: progression-free survival for third-line treatment
See this image and copyright information in PMC

References

    1. Aguirre AJ, Collisson EA.. Advances in the genetics and biology of pancreatic cancer. Cancer J. 2017;23:315-320. https://doi.org/ 10.1097/PPO.0000000000000286 - DOI - PubMed
    1. Neuzillet C, Gaujoux S, Williet N, et al. ; Thésaurus National de Cancérologie Digestive (TNCD). Pancreatic cancer: French clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC). Dig Liver Dis. 2018;50:1257-1271. https://doi.org/ 10.1016/j.dld.2018.08.008 - DOI - PubMed
    1. Oweira H, Petrausch U, Helbling D, et al. Prognostic value of site-specific metastases in pancreatic adenocarcinoma: a surveillance epidemiology and end results database analysis. World J Gastroenterol. 2017;23:1872-1880. https://doi.org/ 10.3748/wjg.v23.i10.1872 - DOI - PMC - PubMed
    1. Ryan D, Hong T, Bardeesy N, et al. Pancreatic adenocarcinoma. N Engl J Med. 2014;371(11):3711039-3711049. - PubMed
    1. Conroy T, Desseigne F, Ychou M, et al. ; Groupe Tumeurs Digestives of Unicancer. FOLFIRINOX vs gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817-1825. https://doi.org/ 10.1056/NEJMoa1011923 - DOI - PubMed

Publication types

MeSH terms