title: Gemcitabine as second-line chemotherapy after Folfirinox failure in advanced pancreatic adenocarcinoma: A retrospective study.
abstract: BACKGROUND
  Pancreatic adenocarcinoma (PA) is diagnosed in most cases at an advanced stage requiring chemotherapy. Folfirinox is the standard first-line treatment. After Folfirinox failure, gemcitabine alone is routinely used as second-line therapy without data supporting this attitude.
  
  
  OBJECTIVE
  Determine the response rate and outcome of patients with advanced PA treated with gemcitabine after Folfirinox failure.
  
  
  METHODS
  We retrospectively analyzed all consecutive patients treated with gemcitabine after Folfirinox failure for a locally advanced or metastatic PA between 2009 and 2015. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Response rate, control rate and tolerability were assessed.
  
  
  RESULTS
  96 patients were included (male, 51%; median age, 62; performance status (PS) 0-1, 47%). Median duration on gemcitabine was 2.1 months. The overall disease control rate was 40%. Median OS was 3.7 months (95%CI: 2.5-5.2) and median PFS was 2.1 months (95%CI: 2.0-2.6). Reasons for treatment discontinuation were mostly progression (51%). Age at diagnosis and PS were independently associated with OS in multivariate analysis (HR of 1.86; p=0.0055 and 2.42; p<0.0001 respectively). 34 patients experienced a grade 3 adverse event.
  
  
  CONCLUSIONS
  This study suggests that gemcitabine is not beneficial to all patients failing on Folfirinox first-line therapy and should be restricted to young patients with good PS.
authors.affiliation: Department of Hepato-Gastroenterology, CHU Rennes, Rennes, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Viaud
authors.affiliation: Department of Medical Oncology, Centre Eugène Marquis, Rennes, France.
authors.forename: Clémence
authors.initials: C
authors.lastname: Brac
authors.affiliation: Department of Hepato-Gastroenterology, Jean Mermoz Hospital, Lyon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Artru
authors.affiliation: Department of Clinical Pharmacology, CHU Rennes, Rennes, France; Clinical Investigation Centre, Inserm 1414, Rennes 1 University, Rennes, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Le Pabic
authors.affiliation: Department of Hepato-Gastroenterology, CHU Rennes, Rennes, France.
authors.forename: Bérengère
authors.initials: B
authors.lastname: Leconte
authors.affiliation: Department of Hepato-Gastroenterology, CHU Rennes, Rennes, France.
authors.forename: Anaïs
authors.initials: A
authors.lastname: Bodère
authors.affiliation: Department of Medical Oncology, Centre Eugène Marquis, Rennes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Pracht
authors.affiliation: Department of Medical Oncology, Centre Eugène Marquis, Rennes, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Le Sourd
authors.affiliation: Department of Medical Oncology, Centre Eugène Marquis, Rennes, France; Rennes 1 University, Rennes , France.
authors.forename: Julien
authors.initials: J
authors.lastname: Edeline
authors.affiliation: Department of Hepato-Gastroenterology, CHU Rennes, Rennes, France; Rennes 1 University, Rennes , France; Inserm ER440 Oncogenesis, Stress & Signaling, Rennes, France. Electronic address: astrid.lievre@chu-rennes.fr.
authors.forename: Astrid
authors.initials: A
authors.lastname: Lièvre
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D018450:Disease Progression; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005472:Fluorouracil; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D005472:Fluorouracil; D000093542:Gemcitabine
keywords: Advanced pancreatic cancer; Folfirinox; Gemcitabine; Second-line chemotherapy