title: Second-Line Treatment in Pancreatic Cancer Patients: Who Profits?--Results From the CONKO Study Group.
abstract: OBJECTIVE
  With increasing numbers of therapeutic options in inoperable pancreatic cancer (PAC), patients tend to receive more than just a first line (FL) therapy.
  
  
  METHODS
  All patients who started FL for PAC at our institution (1997-2012) were retrospectively studied to identify patient's and treatment characteristics. Significant parameters in regard to second-line (SL) related survival were looked for as the basis for a prognostic model. This score was validated in a patient cohort from the CONKO-003 study.
  
  
  RESULTS
  Two hundred eighty of 521 (53.7%) patients received SL therapy, median overall survival (OS) from the beginning of SL (OS2) was 5.1 months. Significant more SL patients had undergone surgery, a higher Karnofsky performance state (KPS) and a duration of FL longer than 4 months.Prognostic factors impacting OS2 were KPS, carbohydrate antigen 19-9 levels at start of SL and the duration of FL. These 3 factors establish a prognostic score--validated in CONKO-003--for SL patients with 3 subgroups: "good" (median OS2, 9.3 months), "intermediate" (median OS2, 7.1 months), "poor" prognosis (median OS2, 3.8 months; P < 0.001).
  
  
  CONCLUSIONS
  Among patients with PAC, more than 50% receive SL therapy. Our prognostic model identifies 3 subgroups and can identify patients with a maximum benefit of SL therapy.
authors.affiliation: From the *Department of Medical Oncology and Haematology, Charité Universitätsmedizin Berlin, Berlin, Germany; and †Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Marianne
authors.initials: M
authors.lastname: Sinn
authors.forename: Louise
authors.initials: L
authors.lastname: Dälken
authors.forename: Jana Käthe
authors.initials: JK
authors.lastname: Striefler
authors.forename: Sven
authors.initials: S
authors.lastname: Bischoff
authors.forename: Nora
authors.initials: N
authors.lastname: Schweitzer
authors.forename: Uwe
authors.initials: U
authors.lastname: Pelzer
authors.forename: Bernd
authors.initials: B
authors.lastname: Dörken
authors.forename: Hanno
authors.initials: H
authors.lastname: Riess
authors.forename: Jens Maria
authors.initials: JM
authors.lastname: Stieler
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018395:CA-19-9 Antigen / Q000032:analysis; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
chemical_list: D018395:CA-19-9 Antigen