title: Second-line therapy after nab-paclitaxel plus gemcitabine or after gemcitabine for patients with metastatic pancreatic cancer.
abstract: BACKGROUND
  This exploratory analysis evaluated second-line (2L) therapy for metastatic pancreatic cancer in a large phase 3 trial (MPACT).
  
  
  METHODS
  Patients who received first-line (1L) nab-paclitaxel+gemcitabine (nab-P+Gem) or Gem were assessed for survival based on 2L treatment received. Multivariate analyses tested influence of treatment effect and prognostic factors on survival.
  
  
  RESULTS
  The majority of 2L treatments (267 out of 347, 77%) contained a fluoropyrimidine (5-fluorouracil or capecitabine). Median total survival (1L randomisation to death) for patients who received 2L treatment after 1L nab-P+Gem vs Gem alone was 12.8 vs 9.9 months (P=0.015). Median total survival for patients with a fluoropyrimidine-containing 2L therapy after nab-P+Gem vs Gem was 13.5 vs 9.5 months (P=0.012). Median 2L survival (duration from start of 2L therapy to death) was 5.3 vs 4.5 months for nab-P+Gem vs Gem, respectively (P=0.886). Factors significantly associated with longer post-1L survival by multivariate analyses included 1L nab-P+Gem, receiving 2L treatment, longer 1L progression-free survival, and Karnofsky performance status⩾70 and neutrophil-to-lymphocyte ratio⩽5 at the end of 1L treatment.
  
  
  CONCLUSIONS
  These findings support the use of 2L therapy for patients with metastatic pancreatic cancer. Fluoropyrimidine-containing treatment after 1L nab-P+Gem is an active regimen with significant clinical effect.
authors.affiliation: Division Oncology, Department of Medicine, University of Washington, 825 Eastlake Avenue E, G4-833, Seattle, WA 98109-1023, USA.
authors.forename: E Gabriela
authors.initials: EG
authors.lastname: Chiorean
authors.affiliation: Translational Genomics Research Institute and HonorHealth, 445 North Fifth Street, Suite 600, Phoenix, AZ 85004, USA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Von Hoff
authors.affiliation: Vall d'Hebron Institute of Oncology (VHIO), P Vall d'Hebron 119-129, Barcelona 08035, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Tabernero
authors.affiliation: Royal Victoria Hospital Barrie Canada, 201 Georgian Drive, Barrie, Ontario, Canada L4M 6M2.
authors.forename: Robert
authors.initials: R
authors.lastname: El-Maraghi
authors.affiliation: Roswell Park Cancer Institute, 665 Elm Street, Buffalo, NY 14203, USA.
authors.forename: Wen Wee
authors.initials: WW
authors.lastname: Ma
authors.affiliation: San Raffaele Scientific Institute, Via Olgetina 60, 20132 Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
authors.affiliation: Monash Health, 246 Clayton Road, Melbourne VIC 3168, Australia.
authors.forename: Marion
authors.initials: M
authors.lastname: Harris
authors.affiliation: Florida Cancer Specialists, 2401 60th Street Ct W, Bradenton, FL 34209-5500, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Whorf
authors.affiliation: Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Liu
authors.affiliation: Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, USA.
authors.forename: Jack Shiansong
authors.initials: JS
authors.lastname: Li
authors.affiliation: Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Manax
authors.affiliation: Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, USA.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Romano
authors.affiliation: Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Lu
authors.affiliation: Department of Medical Oncology, Prince of Wales Hospital, South Sydney Illawarra, Barker Street, Sydney NSW 2031, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
mesh_terms: D000418:Albumins / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D017239:Paclitaxel / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000093542:Gemcitabine
chemical_list: C520255:130-nm albumin-bound paclitaxel; D000418:Albumins; D003841:Deoxycytidine; D017239:Paclitaxel; D000093542:Gemcitabine