Abstract 160P
Background
Since the introduction of nab-paclitaxel plus gemcitabine (nab-P + GEM) as first-line (1L) treatment for metastatic pancreatic adenocarcinoma (mPDAC), optimal second-line (2L) chemotherapy after progression is unclear. We assessed clinical outcomes of 2L chemotherapy for disease that progressed on 1L nab-P + GEM.
Methods
Among the 203 patients previously treated with 1L nab-P + GEM for mPDAC at Asan Medical Center, between February and December 2016, records of 120 patients receiving 2L chemotherapy after progression on nab-P + GEM were retrospectively reviewed. The response rate and survival were evaluated along with analysis of prognostic factors.
Results
Fluoropyrimidine-oxaliplatin doublets (FOLFOX or XELOX) were used in 78 patients (65.0%), fluoropyrimidine monotherapy in 37 (30.8%), and liposomal irinotecan plus fluorouracil in 2 (1.7%). The median progression-free survival (PFS) and overall survival (OS) were 3.29 months and 7.33 month from the start of 2L therapy. Fluoropyrimidine-oxaliplatin regimens and fluoropyrimidine monotherapy did not yield significantly different median PFS (2.89 vs 3.81 months, P = 0.40) or OS (7.04 vs 7.43 months, P = 0.86). A high neutrophil-lymphocyte ratio (>2.2) and a short time to progression with 1L nab-P + GEM (<6.4 months) were independent prognostic factors of poor OS with 2L therapy.
Conclusions
2L fluoropyrimidine-oxaliplatin doublets and fluoropyrimidine monotherapy after failure of 1L nab-P + GEM had modest efficacy, with no differences in treatment outcomes between them. Further investigation is warranted for the optimal 2L chemo-regimens and sequencing of systemic chemotherapy for patients with mPDAC.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
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