title: Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials.
abstract: BACKGROUND
  There is currently no standard of care for the second-line treatment of advanced pancreatic cancer. The aim of this analysis was to compare the different therapeutic approaches in this setting.
  
  
  METHODS
  We carried out a systematic analysis of second-line studies in advanced pancreatic cancer that have progressed on or following gemcitabine and published or presented from 2000 to 2012.
  
  
  RESULTS
  Forty-four clinical trials (t) were identified; of which 34 met the inclusion criteria treating an aggregate total of 1503 patients (n). Patients who received treatments (t: 33; n: 1269) had a median overall survival (OS) of 6 months compared with 2.8 months for patients who received best supportive care only (t: 2; n: 234) (P = 0.013). The gemcitabine and platinum-based combination (t: 5; n: 154) provided a median progression-free survival and OS of 4 and 6 months compared with 1.6 and 5.3 for the rest of the regimens (t: 29; n: 1349) (P = 0.059 and 0.10, respectively) and 2.9 and 5.7 for the combination of 5-fluorouracil and platinum agents (t: 12; n: 450) (P = 0.60 and 0.22, respectively).
  
  
  CONCLUSIONS
  Although not conclusive, these data showed that the advantage of second-line chemotherapy in pancreatic cancer is very limited and there is a need for more studies.
authors.affiliation: Gastrointestinal Malignancy Section, Medical Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA.
authors.forename: O E
authors.initials: OE
authors.lastname: Rahma
authors.forename: A
authors.initials: A
authors.lastname: Duffy
authors.forename: D J
authors.initials: DJ
authors.lastname: Liewehr
authors.forename: S M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: T F
authors.initials: TF
authors.lastname: Greten
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001952:Bridged-Ring Compounds / Q000627:therapeutic use; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D000069347:Erlotinib Hydrochloride; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality; D017671:Platinum Compounds / Q000627:therapeutic use; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011799:Quinazolines / Q000627:therapeutic use; D013534:Survival; D043823:Taxoids / Q000627:therapeutic use; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D001952:Bridged-Ring Compounds; D017671:Platinum Compounds; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D043823:Taxoids; D003841:Deoxycytidine; C080625:taxane; D000069347:Erlotinib Hydrochloride; D005472:Fluorouracil; D000093542:Gemcitabine
keywords: analysis; cancer; pancreatic; review; second-line; treatment