Role of gemcitabine as second-line therapy after progression on FOLFIRINOX in advanced pancreatic cancer: a retrospective analysis.
BACKGROUND
Cancer of the exocrine pancreas is a highly lethal malignancy. Surgical resection is the only potentially curative treatment. Unfortunately, because of the late presentation, the majority have either locally advanced cancer at initial diagnosis. Systemic chemotherapy provides benefit to patients with advanced pancreatic cancer, improving disease-related symptoms and survival when compared to best supportive care alone. Based on fase III study, FOLFIRINOX regimen became the standard first-line treatment. But, the optimal management strategy for patients who fail initial FOLFIRINOX is undefined. Despite the lack of clinical trials that report the real benefit of gemcitabine in patients with advanced exocrine pancreatic cancer as second line treatment. We aim at reporting our experience with this regimen.


METHODS
Patients with advanced exocrine pancreatic cancer who received gemcitabine (1.000 mg/m(2) on days 1, 8 and 15 every 4 weeks) until disease progression, as second-line therapy at our institution were retrospectively evaluated. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method.


RESULTS
A total of 20 patients were reviewed. Median age was 57 years (range, 43-74 years), and 55% were older than 60 years. Most patients were male (80%), had metastatic disease (60%), and ECOG performance status of 0 or 1 (65%). PFS and OS were 2.0 (95% CI, 1.2-2.8) and 5.7 months (95% CI, 3.9-7.4), respectively. There were no deaths due to the treatment.


CONCLUSIONS
In this study, gemcitabine was a reasonable second-line treatment option for patients with advanced pancreatic adenocarcinoma and good ECOG performance status. Phase III trials are urgently needed comparing gemcitabine versus best supportive of care (BSC) can evaluate the real benefit of this chemotherapy after progression on FOLFIRINOX.
Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Aline
A
da Rocha Lino
Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Carina Meira
CM
Abrahão
Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Raphael Moreira
RM
Brandão
Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Jessica Ribeiro
JR
Gomes
Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Andrea Malta
AM
Ferrian
Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Marcel Cerqueira César
MC
Machado
Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Antonio Carlos
AC
Buzaid
Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Fernando Cotait
FC
Maluf
Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Renata D'Alpino
RD
Peixoto
Pancreatic adenocarcinoma; gemcitabine; retrospective analysis; second-line