Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 28, 2012; 18(12): 1357-1364
Published online Mar 28, 2012. doi: 10.3748/wjg.v18.i12.1357
Second-line therapy for gemcitabine-pretreated advanced or metastatic pancreatic cancer
Romain Altwegg, Marc Ychou, Vanessa Guillaumon, Simon Thezenas, Pierre Senesse, Nicolas Flori, Thibault Mazard, Ludovic Caillo, Stéphanie Faure, Emmanuelle Samalin, Eric Assenat
Romain Altwegg, Marc Ychou, Vanessa Guillaumon, Simon Thezenas, Pierre Senesse, Nicolas Flori, Thibault Mazard, Ludovic Caillo, Stéphanie Faure, Emmanuelle Samalin, Eric Assenat, the Oncology and Digestive Endoscopy Department of the CRLC Val d'Aurelle, 34000 Montpellier, France
Author contributions: Altwegg R and Assenat E contributed equally to this work; Ychou M and Assenat E contributed to conception and design of this study; Altwegg R wrote this paper; Mazard T, Flori N and Caillo L performed acquisition of data; Thezenas S and Faure S performed analysis and interpretation of data; Guillaumon V, Senesse P, Samalin E and Assenat E critically revised this paper.
Correspondence to: Romain Altwegg, MD, the Oncology and Digestive Endoscopy Department of CRLC Val d’Aurelle, 34000 Montpellier, France. romain.altwegg@free.fr
Telephone: +33-608-714230 Fax: +33-467-613729
Received: December 16, 2010
Revised: February 7, 2012
Accepted: February 27, 2012
Published online: March 28, 2012
Abstract

AIM: To investigate second-line chemotherapy in gemcitabine-pretreated patients with advanced or metastatic pancreatic cancer [(frequency, response, outcome, course of carbohydrate antigen 19-9 (CA 19-9)].

METHODS: This retrospective study included all patients with advanced or metastatic pancreatic cancer (adenocarcinoma or carcinoma) treated with second-line chemotherapy in our center between 2000 and 2008. All patients received first-line chemotherapy with gemcitabine, and prior surgery or radiotherapy was permitted. We analyzed each chemotherapy protocol for second-line treatment, the number of cycles and the type of combination used. The primary endpoint was overall survival. Secondary endpoints included progression-free survival, response rate, grade 3-4 toxicity, dosage modifications and CA 19-9 course.

RESULTS: A total of eighty patients (38%) underwent a second-line therapy among 206 patients who had initially received first-line treatment with a gemcitabine-based regimen. Median number of cycles was 4 (range: 1-12) and the median duration of treatment was 2.6 mo (range: 0.3-7.4). The overall disease control rate was 40.0%. The median overall survival and progression-free survival from the start of second-line therapy were 5.8 (95% CI: 4.1-6.6) and 3.4 mo (95% CI: 2.4-4.2), respectively. Toxicity was generally acceptable. Median overall survival of patients with a CA 19-9 level declining by more than 20% was 10.3 mo (95% CI: 4.5-11.6) vs 5.2 mo (95% CI: 4.0-6.4) for others (P = 0.008).

CONCLUSION: A large proportion of patients could benefit from second-line therapy, and CA 19-9 allows efficient treatment monitoring both in first and second-line chemotherapy.

Keywords: Second-line; Chemotherapy; Pancreatic cancer; Gemcitabine; Carbohydrate antigen 19-9