title: Second- and third-line chemotherapy in patients with metastatic pancreatic adenocarcinoma: feasibility and potential benefits in a retrospective series of 117 patients.
abstract: BACKGROUND
  Chemotherapy is effective in metastatic pancreatic adenocarcinoma (PAC), but the benefits of second- and third-line chemotherapy remain unclear.
  
  
  METHODS
  We studied all patients followed consecutively for metastatic PAC, and registered at our institution between 1997 and 2006. We retrospectively analyzed the following data in terms of chemotherapy: tumor response; time to tumor progression (TTP) for each line; and overall survival (OS). Efficacy of second-line regimens was assessed using the growth modulation index (GMI).
  
  
  RESULTS
  Out of 117 patients, 99 (85%) received at least one line of chemotherapy, 53 (45%) received two lines and 24 (21%) had three or more lines. Median OS was 6.7 months for all 117 patients, 1.8 months for 18 patients who never received chemotherapy, 4.6 months for 46 patients who received one-line chemotherapy and 11.5 months for 53 patients who received at least two lines. Median OS from the beginning of the second-line was 4.7 months. The GMI demonstrated beneficial effects of second-line treatment on disease progression, with a GMI greater than 1.33 in 57% (30/53) of patients.
  
  
  CONCLUSIONS
  More than half the patients with metastatic PAC progression while receiving one-line chemotherapy achieved better disease control on receiving two lines of treatment.
authors.affiliation: UFR Paris Ile-de-France Ouest, université de Versailles-Saint-Quentin-en-Yvelines, France. jean-baptiste.bachet@apr.aphp.fr
authors.forename: J-B
authors.initials: JB
authors.lastname: Bachet
authors.forename: E
authors.initials: E
authors.lastname: Mitry
authors.forename: A
authors.initials: A
authors.lastname: Lièvre
authors.forename: C
authors.initials: C
authors.lastname: Lepère
authors.forename: J-N
authors.initials: JN
authors.lastname: Vaillant
authors.forename: G
authors.initials: G
authors.lastname: Declety
authors.forename: H
authors.initials: H
authors.lastname: Parlier
authors.forename: J-F
authors.initials: JF
authors.lastname: Emile
authors.forename: C
authors.initials: C
authors.lastname: Julié
authors.forename: P
authors.initials: P
authors.lastname: Rougier
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents