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
ARTICLE HIGHLIGHTS
Research background

Pancreatic adenocarcinoma is one of the leading causes of death from cancer in the world, and it carries a grim prognosis. Most patients are diagnosed with advanced disease, thus systemic chemotherapy plays a key role in treatment. 5-fluorouracil combination regimens may be considered in patients who have failed first-line gemcitabine-based chemotherapy. However, due to toxicity, these regimens are not considered for elderly patients or those with poor performance status.

Research motivation

Capecitabine has shown activity as a first-line treatment in patients with metastatic pancreatic cancer, with a relatively good response. Also, S-1 has shown favorable antitumor activity in several phase II studies in patients with metastatic pancreatic cancer. Thus, oral chemotherapy, such as capecitabine or S-1, can be a second-line treatment option for patients with poor performance status, due to less toxicity. However, until recently, few studies have compared the efficacy and toxicity of these two drugs.

Research objectives

This study investigated the efficacy and toxicity of oral chemotherapy, with capecitabine or S-1 as the second-line treatment in patients with pancreatic cancer who have failed to gemcitabine-based therapy.

Research methods

This study used a retrospective cohort analysis to compare efficacy and toxicity between capecitabine and S-1 in patients with gemcitabine-refractory pancreatic cancer. The survival outcomes of the two groups were compared through a Cox regression model, and displayed using Kaplan-Meier curve.

Research results

The objective response rates were similar in both groups with no statistical difference. The objective response rate in this study was consistent with the results of previous studies. There was no significant difference in the median overall survival between the two groups. Median progression-free survival was longer in the S-1 group than in the capecitabine group, however, differences in duration of response assessment of the two regimens may affect the results. Grade 3 or 4 toxicity was similar in both groups; however, hand-foot syndrome was more frequently observed in the capecitabine group.

Research conclusions

Capecitabine and S-1 showed relatively favorable efficacy and low toxicity, which can be considered as a second-line treatment option for gemcitabine-refractory pancreatic cancer patients with poor performance status. Hand-foot syndrome was significantly less common in the S-1 group, thus S-1 may be considered in patients who have experienced intolerable hand-foot syndrome during capecitabine treatment.

Research perspectives

Our study showed that oral chemotherapy can be considered as second-line treatment in patients with pancreatic cancer after gemcitabine failure. This study is a retrospective analysis with small sample size, thus further randomized prospective study are needed to confirm our preliminary results.