181P - The emerging role of third-line gemcitabine plus nab-paclitaxel in advanced pancreatic adenocarcinoma

Background

There are no standardised, recognised regimens for third line treatment of advanced pancreatic cancer, with most clinicians using best supportive care in this scenario. Gemcitabine plus nab-paclitaxel and FOLFIRINOX are non-cross resistant regimens. This generates the hypothesis that patients who responded well in the first line setting to gemcitabine and nab-paclitaxel could respond again if rechallenged in the third line setting, after second line FOLFIRINOX.

Methods

A retrospective analysis was conducted via an electronic database from two of our institutions, of locally advanced or metastatic pancreatic adenocarcinoma patients who were treated with gemcitabine plus nab-paclitaxel both as a first line and third line chemotherapy regimen between January 2013 and July 2019. All patients had an ECOG performance status of 2 or less. Overall survival (OS) was estimated by the Kaplan-Meier method.

Results

We identified 30 patients in our analysis. 63% of the patients were female, with the median age of all patients at diagnosis being 67 (range, 38 – 82). 60% of the studied patients had locally advanced disease at diagnosis. Median OS from diagnosis was 39.0 months (95% CI, 34.0 – 66.0). Median OS from third-line re-initiation of gemcitabine plus nab-paclitaxel was 29.0 months (95% CI, 9.0 – 36.0).

Conclusions

Patient who maintain a good performance status after second line treatment present a management dilemma, as these patients are often reluctant to accept best supportive care when they feel well enough to tolerate another line of chemotherapy. The median OS (29 months) and age (67) is surprising, but probably represents the selection bias of patients who retain sufficient performance status to undergo third line therapy. Patients who have receive first line gemcitabine plus nab-paclitaxel, and second line FOLFIRINOX whilst maintaining good performance status, should be considered for re-treatment with gemcitabine plus nab-paclitaxel, as evidenced by our data from two of our institutions. Phase III studies would be highly beneficial to further investigate this as a potential standard of care for third-line treatment in this group.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

St John of God Hospital Subiaco.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.