title: Second-line therapy for gemcitabine-pretreated advanced or metastatic pancreatic cancer.
abstract: OBJECTIVE
  To investigate second-line chemotherapy in gemcitabine-pretreated patients with advanced or metastatic pancreatic cancer [(frequency, response, outcome, course of carbohydrate antigen 19-9 (CA 19-9)].
  
  
  METHODS
  This retrospective study included all patients with advanced or metastatic pancreatic cancer (adenocarcinoma or carcinoma) treated with second-line chemotherapy in our center between 2000 and 2008. All patients received first-line chemotherapy with gemcitabine, and prior surgery or radiotherapy was permitted. We analyzed each chemotherapy protocol for second-line treatment, the number of cycles and the type of combination used. The primary endpoint was overall survival. Secondary endpoints included progression-free survival, response rate, grade 3-4 toxicity, dosage modifications and CA 19-9 course.
  
  
  RESULTS
  A total of eighty patients (38%) underwent a second-line therapy among 206 patients who had initially received first-line treatment with a gemcitabine-based regimen. Median number of cycles was 4 (range: 1-12) and the median duration of treatment was 2.6 mo (range: 0.3-7.4). The overall disease control rate was 40.0%. The median overall survival and progression-free survival from the start of second-line therapy were 5.8 (95% CI: 4.1-6.6) and 3.4 mo (95% CI: 2.4-4.2), respectively. Toxicity was generally acceptable. Median overall survival of patients with a CA 19-9 level declining by more than 20% was 10.3 mo (95% CI: 4.5-11.6) vs 5.2 mo (95% CI: 4.0-6.4) for others (P = 0.008).
  
  
  CONCLUSIONS
  A large proportion of patients could benefit from second-line therapy, and CA 19-9 allows efficient treatment monitoring both in first and second-line chemotherapy.
authors.affiliation: Oncology and Digestive Endoscopy Department of the CRLC Val d'Aurelle, 34000 Montpellier, France. romain.altwegg@free.fr
authors.forename: Romain
authors.initials: R
authors.lastname: Altwegg
authors.forename: Marc
authors.initials: M
authors.lastname: Ychou
authors.forename: Vanessa
authors.initials: V
authors.lastname: Guillaumon
authors.forename: Simon
authors.initials: S
authors.lastname: Thezenas
authors.forename: Pierre
authors.initials: P
authors.lastname: Senesse
authors.forename: Nicolas
authors.initials: N
authors.lastname: Flori
authors.forename: Thibault
authors.initials: T
authors.lastname: Mazard
authors.forename: Ludovic
authors.initials: L
authors.lastname: Caillo
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Faure
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Samalin
authors.forename: Eric
authors.initials: E
authors.lastname: Assenat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D018395:CA-19-9 Antigen / Q000378:metabolism; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D012189:Retrospective Studies; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D018395:CA-19-9 Antigen; D003841:Deoxycytidine; D000093542:Gemcitabine