Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2019; 11(11): 1021-1030
Published online Nov 15, 2019. doi: 10.4251/wjgo.v11.i11.1021
Oral chemotherapy for second-line treatment in patients with gemcitabine-refractory advanced pancreatic cancer
Se Jun Park, Hyunho Kim, Kabsoo Shin, Myung Ah Lee, Tae Ho Hong
Se Jun Park, Hyunho Kim, Kabsoo Shin, Myung Ah Lee, Division of Medical Oncology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul 100744, South Korea
Tae Ho Hong, Department of General Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul 100744, South Korea
Author contributions: All authors helped to perform the research; Park SJ was involved with manuscript writing, drafting conception and design, acquisition of data, performing procedures and data analysis; Kim HH, Shin KS, Hong TH contributed to writing the manuscript; Lee MA contributed to writing the manuscript, drafting conception and design, performing procedures and data analysis.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Catholic University of Korea, Seoul St. Mary’s Hospital.
Informed consent statement: Patients were not required to give informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflict-of-interest related to this research.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Myung Ah Lee, MD, PhD, Professor, Division of Medical Oncology, Department of Internal Medicine, Cancer research institute, College of Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, 222 Banpo-daero, Secho-gu, Seoul 100744, South Korea. angelamd@catholic.ac.kr
Telephone: +82-2-22586044 Fax: +82-2-5993589
Received: May 20, 2019
Peer-review started: May 23, 2019
First decision: July 31, 2019
Revised: September 3, 2019
Accepted: September 12, 2019
Article in press: September 13, 2019
Published online: November 15, 2019
Processing time: 179 Days and 4.1 Hours
Abstract
BACKGROUND

There is no standard therapy for second-line treatment of gemcitabine-refractory pancreatic cancer patients with poor performance status. A combination of chemotherapy drugs 5-fluorouracil (5-FU), leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) or 5-fluorouracil/leucovorin plus nanoliposomal irinotecan can be considered as second-line treatment for such patients; however, due to toxicity, none of the regimens are recommended for patients with poor performance. Capecitabine or S-1 has relatively low toxicity and can be considered a treatment option for gemcitabine-refractory pancreatic cancer.

AIM

To investigate the efficacy and toxicity of oral chemotherapy as second-line treatment in patients with pancreatic cancer.

METHODS

Patients who had progressive disease after first-line gemcitabine-based chemotherapy were retrospectively analyzed between January 2011 and December 2018. They were treated with capecitabine or S-1 as the second-line treatment. Capecitabine was administered as a 2500 mg/m2 divided dose on days 1-14, followed by a 1-wk rest. S-1 was taken orally based on the patient’s body surface area for 28 d, followed by 2-wk of rest. Progression-free survival and overall survival were used to compare efficacy of capecitabine and S-1.

RESULTS

Of the 81 patients, 41 were treated with capecitabine and 40 with S-1. The median time to treatment failure in both groups was 1.5 mo (P = 0.425). The objective response rate was similar in the two groups: 9.8% with capecitabine and 2.5% with S-1 (P = 0.359). Median progression-free survival was longer in the S-1 group than in the capecitabine group (S-1 2.7 mo, capecitabine 2.0 mo, P = 0.003). There was no significant difference in the median overall survival between the capecitabine and S-1 groups (4.3 mo vs 5.0 mo, P = 0.092). Grade 3 or 4 hand-foot syndrome was significantly more common in the capecitabine group than in the S-1 group (14.6% vs 0%, P = 0.026).

CONCLUSION

Capecitabine or S-1 can be used as a second-line treatment for patients with advanced pancreatic cancer with poor performance status after progression to a gemcitabine-based regimen.

Keywords: Pancreatic cancer, Gemcitabine-refractory, Capecitabine, S-1, Second-line treatment

Core tip: To date, there is no standard regimen for patients with gemcitabine-refractory pancreatic cancer with poor performance status. In this study, we compared the efficacy and toxicity of capecitabine and S-1 for such patients. The median progression free survival was longer in the S-1 group than in the capecitabine group; however, there were no statistical differences in their overall survival. Among grade 3 or 4 toxicity, hand-foot syndrome was significantly more common in the capecitabine group than in the S-1 group. Thus, oral chemotherapy can be considered as a second-line treatment in gemcitabine-refractory pancreatic cancer patients with poor performance status.