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Sezgin Y, Karhan O, Aldemir MN, Ürün M, Erçek BM, Urakcı Z, Arvas H, Tunç S, Erdem M, Yerlikaya H, İleri S, Aydın İ, Bicer A, Kömüroğlu AU, Majidova N, Gökçek S, Demir H, Yıldız S, Akbaş S, Özen E, Kahya BU, Sali M, Anık H, Aykut T, Araz M, Alkan A, Özçelik M, Sakin A, Aykan MB, Mehtıyev M, Demir B, Başer MN, Sönmez M, Gültürk İ, Avcı N, Urvay S, Arıcı MÖ, Kalender ME, Yıldırım M, Solmaz AA, Gürbüz M, Ergün Y. Efficacy of gemcitabine plus nab-paclitaxel in second-line treatment of metastatic pancreatic cancer. Sci Rep 2025; 15:11675. [PMID: 40188172 PMCID: PMC11972389 DOI: 10.1038/s41598-025-96157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 03/26/2025] [Indexed: 04/07/2025] Open
Abstract
Despite numerous studies on second-line therapies in metastatic pancreatic cancer, there is no randomized study evaluating the efficacy of gemcitabine plus nab-paclitaxel as a second-line treatment. This study aims to examine the efficacy of gemcitabine plus nab-paclitaxel in second-line therapy. In this retrospective study, a total of 218 patients from 23 centers were included. The primary endpoint was progression-free survival (PFS), secondary endpoints included overall survival (OS), treatment efficacy based on ECOG performance status (PS), and tumor marker (CEA, CA 19 - 9) levels. In the second-line treatment with gemcitabine plus nab-paclitaxel, the median PFS was 5.1 months (95% CI, 5.6 to 7.1), and the median OS was 8.6 months (95% CI, 7.3 to 10.0). Median PFS was 6.6 months in patients with normal CEA levels compared to 4.4 months in patients with high CEA levels (P = 0.01). Median PFS was 6 months in patients with ECOG PS 0-1 compared to 3.8 months in patients with PS 2 (P < 0.01). This study demonstrates the contribution of gemcitabine plus nab-paclitaxel in both OS and PFS in second-line treatment of metastatic pancreatic cancer. It was found to be a good option especially for young patients with good ECOG PS.
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Affiliation(s)
- Yasin Sezgin
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey.
| | - Oğur Karhan
- Department of Medical Oncology, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
| | - Mehmet Naci Aldemir
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Muslih Ürün
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Berrak Mermit Erçek
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Zuhat Urakcı
- Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Hayati Arvas
- Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Sezai Tunç
- Urfa Mehmet Akif Inan Regional Training Research Hospital Oncology Department, Şanlıurfa, Turkey
| | - Mehmet Erdem
- Department of Internal Medicine, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Halis Yerlikaya
- Diyarbakır private Batı Hospital Medical Oncology Department, Diyarbakır, Turkey
| | - Serdar İleri
- Gazi Yaşargil Regional Training Research Hospital Oncology Department, Diyarbakır, Turkey
| | - İbrahim Aydın
- Department of Internal Medicine, Van Regional Training Research Hospital, Van, Turkey
| | - Abdurrahman Bicer
- Department of Internal Medicine, Van Regional Training Research Hospital, Van, Turkey
| | - Ahmet Ufuk Kömüroğlu
- Health Service Vocational School of Higher Education, Van Yüzüncü Yıl University, Van, Turkey
| | - Nargiz Majidova
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Savaş Gökçek
- Department of Medical Oncology, Faculty of Medicine, Eyül University, İzmir, Turkey
| | - Hacer Demir
- Department of Medical Oncology, Faculty of Medicine, Afyon Karahisar University, Afyonkarahisar, Turkey
| | - Sedat Yıldız
- Department of Medical Oncology, Faculty of Medicine, Afyon Karahisar University, Afyonkarahisar, Turkey
| | - Sinem Akbaş
- Department of Medical Oncology, Faculty of Medicine, Koç University, Istanbul, Turkey
| | - Esra Özen
- Department of Medical Oncology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Burcu Ulaş Kahya
- Department of Medical Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mürsel Sali
- Department of Medical Oncology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Hicran Anık
- Abdurrahman Yurtaslan Regional Training Research Hospital Oncology Department, Ankara, Turkey
| | - Talat Aykut
- Department of Medical Oncology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Murat Araz
- Department of Medical Oncology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ali Alkan
- Department of Medical Oncology, Faculty of Medicine, Muğla Sıtkı Kocaman University, Muğla, Turkey
| | - Melike Özçelik
- Ümraniye Regional Training Research Hospital Oncology Department, Istanbul, Turkey
| | - Abudllah Sakin
- İstanbul Private Medicalpark Hospital Medical Oncology Department, Istanbul, Turkey
| | - Musa Barış Aykan
- Gülhane Regional Training Research Hospital Oncology Department, Ankara, Turkey
| | - Mirmehdi Mehtıyev
- Department of Medical Oncology, Bilkent City Hospital, Ankara, Turkey
| | - Bilgin Demir
- Faculty of Medicine, Department of Medical Oncology, Adana Menderes University, Aydın, Turkey
| | - Mehmet Nuri Başer
- Faculty of Medicine, Department of Medical Oncology, Adana Menderes University, Aydın, Turkey
| | - Müge Sönmez
- Department of Medical Oncology, Faculty of Medicine, Department of Medical Oncology, Ordu State Hospital, Sanko University, 26 İstanbul Regional, Istanbul, Turkey
| | - İlkay Gültürk
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Nilüver Avcı
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Semiha Urvay
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Mustafa Özgür Arıcı
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Mehmet Emin Kalender
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Mustafa Yıldırım
- Department of Medical Oncology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Ali Alper Solmaz
- Department of Medical Oncology, Adana City Hospital, Adana, Turkey
| | - Mustafa Gürbüz
- Department of Medical Oncology, Adana City Hospital, Adana, Turkey
| | - Yakup Ergün
- Department of Medical Oncology, Diyarbakır Private Bower Hospital, Diyarbakır, Turkey
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Yang SH, Huang CJ, Chiu SC, Kao HF, Lu LC, Shan YS, Kuo SH, Yeh KH. Improved survival with adding-on strategy after failure of nanoliposomal irinotecan plus 5-fluorouracil and leucovorin in metastatic pancreatic adenocarcinoma. J Formos Med Assoc 2025. [DOI: 10.1016/j.jfma.2025.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2025] Open
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3
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Cheng J, Zhu T, Liu S, Zhou J, Wang X, Liu G. Prediction of synergistic gemcitabine-based combination treatment through a novel tumor stemness biomarker NANOG in pancreatic cancer. RSC Med Chem 2024:d4md00165f. [PMID: 39297058 PMCID: PMC11404023 DOI: 10.1039/d4md00165f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 09/04/2024] [Indexed: 09/21/2024] Open
Abstract
Gemcitabine remains a first-class chemotherapeutic drug for pancreatic cancer. However, due to the rapid development of gemcitabine resistance in pancreatic cancer, gemcitabine alone or in combination with other anti-cancer drugs only showed limited effect in the clinic. It is extremely challenging to effectively and efficiently determine the optimal drug regimens. Thus, identification of appropriate prediction biomarkers is critical for the rational design of gemcitabine-based therapeutic options. Herein, a pancreatic cancer stem cell (PCSC) model exhibiting chemoresistance to gemcitabine was used to test the activity of clinical cancer drugs in the presence or absence of gemcitabine. As determined by combinatorial treatment, several types of drugs resensitized gemcitabine-resistant PCSCs to gemcitabine, with sorafenib (EGFR inhibitor)/gemcitabine and sunitinib (TBK1 inhibitors)/gemcitabine drug combinations being the most preferred treatments for PCSCs. Following the validation of the PCSC model by an antibody array test of 15-gene expression of stemness biomarkers, NANOG showed markedly different expression in PCSCs compared to the parental cells. From comprehensive analysis of stem cell index versus combination index, a stemness-related correlation model was successfully constructed to demonstrate the correlation between NANOG expression and synergism. Cancer cell stemness was ascertained to be highly relevant to NANOG overexpression that can be abrogated by synergized gemcitabine-drug combinations. Therefore, NANOG works as a therapeutic biomarker for predicating efficient combinatorial treatment of gemcitabine in pancreatic cancer.
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Affiliation(s)
- Jiongjia Cheng
- Key Laboratory of Advanced Functional Materials of Nanjing, School of Environmental Science, Nanjing Xiaozhuang University Nanjing 211171 China
| | - Ting Zhu
- Key Laboratory of Advanced Functional Materials of Nanjing, School of Environmental Science, Nanjing Xiaozhuang University Nanjing 211171 China
| | - Shaoxian Liu
- Key Laboratory of Advanced Functional Materials of Nanjing, School of Environmental Science, Nanjing Xiaozhuang University Nanjing 211171 China
| | - Jiayu Zhou
- Key Laboratory of Advanced Functional Materials of Nanjing, School of Environmental Science, Nanjing Xiaozhuang University Nanjing 211171 China
| | - Xiaofeng Wang
- Key Laboratory of Advanced Functional Materials of Nanjing, School of Environmental Science, Nanjing Xiaozhuang University Nanjing 211171 China
| | - Guangxiang Liu
- Key Laboratory of Advanced Functional Materials of Nanjing, School of Environmental Science, Nanjing Xiaozhuang University Nanjing 211171 China
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Giordano G, Milella M, Landriscina M, Bergamo F, Tirino G, Santaniello A, Zaniboni A, Vasile E, De Vita F, Re GL, Vaccaro V, Giommoni E, Natale D, Conca R, Santini D, Maiorino L, Sanna G, Ricci V, Iop A, Montesarchio V, Procaccio L, Noventa S, Bianco R, Febbraro A, Lonardi S, Tortora G, Sperduti I, Melisi D. Prognostic analysis and outcomes of metastatic pancreatic cancer patients receiving nab-paclitaxel plus gemcitabine as second or later-line treatment. Cancer Med 2024; 13:e7345. [PMID: 38924262 PMCID: PMC11199338 DOI: 10.1002/cam4.7345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/11/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Pancreatic cancer (PC) first-line therapy often consists of polychemotherapy regimens, but choosing a second-line therapy after disease progression, especially following first-line FOLFIRINOX, remains a clinical challenge. This study presents results from a large, multicenter, retrospective analysis of Italian patients with metastatic PC (mPC) treated with Nab-paclitaxel/Gemcitabine (AG) as second or later line of treatment. Main objective of the study is to identify prognostic factors that could inform treatment decisions. METHODS The study included 160 mPC patients treated with AG in 17 Italian institutions. AG was administered according to labelling dose, until disease progression, unacceptable toxicity or patient refusal. Variations in schedules, dose modifications, supportive measures, and response evaluation were determined by individual clinicians' practice. RESULTS AG was well-tolerated and exhibited promising clinical activity. The overall response rate (ORR) and the disease control rate (DCR) were 22.5% and 45.6%, respectively. Median progression-free survival (PFS) and overall survival (OS) were 3.9 and 6.8 months, respectively. Among the patients who received AG as a second-line therapy (n = 111, 66.9%), median PFS and OS were 4.2 and 7.4 months, respectively. Notably, in the 76 patients (68%) receiving AG after first-line FOLFIRINOX, an ORR of 19.7% and a DCR of 46.0% were observed, resulting in a median PFS of 3.5 and median OS of 5.7 months. The study identified specific clinical or laboratory parameters (LDH, NLR, fasting serum glucose, liver metastases, ECOG PS, and first-line PFS) as independent prognostic factors at multivariate level. These factors were used to create a prognostic nomogram that divided patients into three risk classes, helping to predict second-line OS and PFS. CONCLUSIONS This study represents the largest real-world population of mPC patients treated with AG as a second or later line of therapy. It supports the feasibility of this regimen following first-line FOLFIRINOX, particularly in patients with specific clinical and laboratory characteristics who derived prolonged benefit from first-line therapy.
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Affiliation(s)
- Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Michele Milella
- Section of Oncology, Department of MedicineUniversity of Verona School of Medicine and Verona University Hospital TrustVeronaItaly
| | - Matteo Landriscina
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | | | - Giuseppe Tirino
- Unit of Medical Oncology, Sacro Cuore di Gesu'—Fatebenefratelli HospitalBeneventoItaly
| | - Antonio Santaniello
- Department of Clinical Medicine and SurgeryUniversity of Naples "Federico II"NaplesItaly
| | | | - Enrico Vasile
- Unit of Medical Oncology 2Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision MedicineUniversity of Campania "L. Vanvitelli"NaplesItaly
| | - Giovanni Lo Re
- Medical Oncology and Immune‐Related TumorsCentro di Riferimento Oncologico di Aviano (CRO), IRCCSAvianoItaly
| | - Vanja Vaccaro
- Medical Oncology 1IRCCS Regina Elena National Cancer InstituteRomeItaly
| | - Elisa Giommoni
- Medical Oncology UnitCareggi University HospitalFlorenceItaly
| | | | - Raffaele Conca
- Division of Medical Oncology, Department of Onco‐HematologyIRCCS‐CROB, Referral Cancer Center of BasilicataRionero in VultureItaly
| | - Daniele Santini
- Medical Oncology AUniversity of Rome, Policlinico Umberto I, "La SapienzaRomeItaly
| | | | - Gianni Sanna
- Medical OncologyIstituto Ospedaliero dell'Università di SassariSassariItaly
| | - Vincenzo Ricci
- Medical Oncology UnitAzienda Ospedaliera di Rilievo Nazionale ‘San Pio’BeneventoItaly
| | - Aldo Iop
- Department of OncologyAzienda Sanitaria Universitaria Giuliano Isontina (ASUGI)TriesteItaly
| | | | | | - Silvia Noventa
- Medical Oncology UnitFondazione PoliambulanzaBresciaItaly
| | - Roberto Bianco
- Department of Clinical Medicine and SurgeryUniversity of Naples "Federico II"NaplesItaly
| | - Antonio Febbraro
- Unit of Medical Oncology, Sacro Cuore di Gesu'—Fatebenefratelli HospitalBeneventoItaly
| | - Sara Lonardi
- Department of OncologyVeneto Institute of Oncology IRCCSPadovaItaly
| | - Giampaolo Tortora
- Oncologia MedicaFondazione Policlinico Universitario Gemelli IRCCSRomeItaly
- Oncologia MedicaUniversità Cattolica del Sacro CuoreRomeItaly
| | - Isabella Sperduti
- Biostatistical UnitIRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici OspitalieriRomeItaly
| | - Davide Melisi
- Section of Oncology, Department of MedicineUniversity of Verona School of Medicine and Verona University Hospital TrustVeronaItaly
- Investigational Cancer Therapeutics Clinical UnitAzienda Ospedaliera Universitaria IntegrataVeronaItaly
- Digestive Molecular Clinical Oncology Research UnitUniversity of VeronaVeronaItaly
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5
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Yoon H, Shin Y, Ryoo BY, Jeong H, Park I, Seo DW, Lee SS, Park DH, Song TJ, Oh D, Hwang DW, Lee JH, Song KB, Park Y, Kwak BJ, Hong SM, Park JH, Kim SC, Kim KP, Yoo C. Clinical outcomes of second-line therapy following disease progression on first-line modified FOLFIRINOX for borderline resectable and locally advanced pancreatic adenocarcinoma. Pancreatology 2024; 24:424-430. [PMID: 38395676 DOI: 10.1016/j.pan.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/21/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Modified FOLFIRINOX (mFOLFIRINOX) is one of the standard first-line therapies in borderline resectable pancreatic cancer (BRPC) and locally advanced unresectable pancreatic cancer (LAPC). However, there is no globally accepted second-line therapy following progression on mFOLFIRINOX. METHODS Patients with BRPC and LAPC (n = 647) treated with first-line mFOLFIRINOX between January 2017 and December 2020 were included in this retrospective analysis. The details of the treatment outcomes and patterns of subsequent therapy after mFOLFIRINOX were reviewed. RESULTS With a median follow-up duration of 44.2 months (95% confidence interval [CI], 42.3-47.6), 322 patients exhibited disease progression on mFOLFIRINOX-locoregional progression only in 177 patients (55.0%) and distant metastasis in 145 patients (45.0%). The locoregional progression group demonstrated significantly longer post-progression survival (PPS) than that of the distant metastasis group (10.1 vs. 7.3 months, p = 0.002). In the locoregional progression group, survival outcomes did not differ between second-line chemoradiation/radiotherapy and systemic chemotherapy (progression-free survival with second-line therapy [PFS-2], 3.2 vs. 4.3 months; p = 0.649; PPS, 10.7 vs. 10.2 months; p = 0.791). In patients who received second-line systemic chemotherapy following progression on mFOLFIRINOX (n = 211), gemcitabine plus nab-paclitaxel was associated with better disease control rates (69.2% vs. 42.3%, p = 0.005) and PFS-2 (3.8 vs. 1.7 months, p = 0.035) than gemcitabine monotherapy. CONCLUSIONS The current study showed the real-world practice pattern of subsequent therapy and clinical outcomes following progression on first-line mFOLFIRINOX in BRPC and LAPC. Further investigation is necessary to establish the optimal therapy after failure of mFOLFIRINOX.
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Affiliation(s)
- Hyunseok Yoon
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeokyeong Shin
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Baek-Yeol Ryoo
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyehyun Jeong
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Inkeun Park
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wan Seo
- Departments of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Soo Lee
- Departments of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do Hyun Park
- Departments of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Jun Song
- Departments of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dongwook Oh
- Departments of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae Wook Hwang
- Departments of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Hoon Lee
- Departments of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki Byung Song
- Departments of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yejong Park
- Departments of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bong Jun Kwak
- Departments of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Mo Hong
- Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-Hong Park
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Song Cheol Kim
- Departments of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyu-Pyo Kim
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Changhoon Yoo
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Alfano MS, Garnier J, Palen A, Ewald J, Piana G, Poizat F, Mitry E, Delpero JR, Turrini O. Peak Risk of Recurrence Occurs during the First Two Years after a Pancreatectomy in Patients Receiving Neoadjuvant FOLFIRINOX. Cancers (Basel) 2023; 15:5151. [PMID: 37958326 PMCID: PMC10649429 DOI: 10.3390/cancers15215151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/07/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
No codified/systematic surveillance program exists for borderline/locally advanced pancreatic ductal carcinoma treated with neoadjuvant FOLFIRINOX and a secondary resection. This study aimed to determine the trend of recurrence in patients who were managed using such a treatment strategy. From 2010, 101 patients received FOLFIRINOX and underwent a pancreatectomy, in a minimum follow-up of 5 years. Seventy-one patients (70%, R group) were diagnosed with recurrence after a median follow-up of 11 months postsurgery. In the multivariable analysis, patients in the R-group had a higher rate of weight loss (p = 0.018), higher carbohydrate antigen (CA 19-9) serum levels at diagnosis (p = 0.012), T3/T4 stage (p = 0.017), and positive lymph nodes (p < 0.01) compared to patients who did not experience recurrence. The risk of recurrence in patients with T1/T2 N0 R0 was the lowest (19%), and all recurrences occurred during the first two postoperative years. The peak risk of recurrence for the entire population was observed during the first two postoperative years. The probability of survival decreased until the second year and rebounded to 100% permanently, after the ninth postoperative year. Close monitoring is needed at reduced intervals during the first 2 years following a pancreatectomy and should be extended to later than 5 years for those with unfavorable pathological results.
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Affiliation(s)
- Marie-Sophie Alfano
- Department of Surgical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (M.-S.A.)
| | - Jonathan Garnier
- Department of Surgical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (M.-S.A.)
| | - Anaïs Palen
- Department of Surgical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (M.-S.A.)
| | - Jacques Ewald
- Department of Surgical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (M.-S.A.)
| | - Gilles Piana
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Flora Poizat
- Department of Pathology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Emmanuel Mitry
- Department of Oncology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Jean-Robert Delpero
- Department of Surgical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (M.-S.A.)
- Faculté de Médecine, Aix-Marseille University, 13005 Marseille, France
| | - Olivier Turrini
- Department of Surgical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France; (M.-S.A.)
- Faculté de Médecine, Aix-Marseille University, 13005 Marseille, France
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7
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Petrelli F, Parisi A, Tomasello G, Mini E, Arru M, Russo A, Garrone O, Khakoo S, Ardito R, Ghidini M. Comparison of different second line treatments for metastatic pancreatic cancer: a systematic review and network meta-analysis. BMC Gastroenterol 2023; 23:212. [PMID: 37337148 DOI: 10.1186/s12876-023-02853-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 06/13/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND In metastatic pancreatic ductal adenocarcinoma (mPDAC), first line treatment options usually include combination regimens of folinic acid, 5-fluorouracil (5-FU), irinotecan, and oxaliplatin (FOLFIRINOX or mFOLFIRINOX) or gemcitabine based regimens such as in combination with albumin-bound paclitaxel (GEM + nab-PTX). After progression, multiple regimens including NALIRI + 5-FU and folinic acid, FOLFIRINOX, 5-FU-based oxaliplatin doublets (OFF, FOLFOX, or XELOX), or 5-FU-based monotherapy (FL, capecitabine, or S-1) are considered appropriate by major guidelines. This network meta-analysis (NMA) aimed to compare the efficacy of different treatment strategies tested as second-line regimens for patients with mPDAC after first-line gemcitabine-based systemic treatment. METHODS Randomized phase II and III clinical trials (RCTs) were included if they were published or presented in English. Trials of interest compared two active systemic treatments as second-line regimens until disease progression or unacceptable toxicity. We performed a Bayesian NMA with published hazard ratios (HRs) and 95%confidence intervals (CIs) to evaluate the comparative effectiveness of different second-line therapies for mPDAC. The main outcomes of interest were overall survival (OS) and progression free survival (PFS), secondary endpoints were grade 3-4 toxicities. We calculated the relative ranking of agents for each outcome as their surface under the cumulative ranking (SUCRA). A higher SUCRA score meant a higher ranking for efficacy outcomes. RESULTS A NMA of 9 treatments was performed for OS (n = 2521 patients enrolled). Compared with 5-FU + folinic acid both irinotecan or NALIRI + fluoropyrimidines had a trend to better OS (HR = 0.76, 95%CI 0.21-2.75 and HR = 0.74, 95%CI 0.31-1.85). Fluoropyrimidines + folinic acid + oxaliplatin were no better than the combination without oxaliplatin. The analysis of treatment ranking showed that the combination of NALIRI + 5-FU + folinic acid was most likely to yield the highest OS results (SUCRA = 0.7). Furthermore, the NMA results indicated that with the highest SUCRA score (SUCRA = 0.91), NALIRI + 5-FU + folinic acid may be the optimal choice for improved PFS amongst all regimens studied. CONCLUSIONS According to the NMA results, NALIRI + 5-FU, and folinic acid may represent the best second-line treatment for improved survival outcomes in mPDAC. Further evidence from prospective trials is needed to determine the best treatment option for this group of patients.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, ASST Bergamo ovest, Treviglio (BG), 24047, Italy
| | - Alessandro Parisi
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Via Conca 71, Ancona, 60126, Italy.
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, 67100, Italy.
| | - Gianluca Tomasello
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Emanuele Mini
- General Surgery Unit, ASST Bergamo ovest, Treviglio (BG), 24047, Italy
| | - Marcella Arru
- General Surgery Unit, ASST Bergamo ovest, Treviglio (BG), 24047, Italy
| | - Alessandro Russo
- General Surgery Unit, ASST Bergamo ovest, Treviglio (BG), 24047, Italy
| | - Ornella Garrone
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Shelize Khakoo
- Department of Medicine, The Royal Marsden Hospital, London, SW3 6JJ, UK
| | - Raffaele Ardito
- Oncological Day Hospital, IRCCS Centro di Riferimento Oncologico Della Basilicata (CROB), Via Padre Pio 1, Rionero in Vulture PZ, 85028, Italy
| | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
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8
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Sütcüoğlu O, Doğan A, Yilmaz F, Şahin AB, Şahin TK, Esen SA, Erol C, Üner A, Özet A, Turan N, Eraslan E, Deligönül A, Odabaş H, Günel N, Uçar G, Dede DŞ, Dizdar Ö, Çubukçu E, Öksüzoğlu ÖB, Emre Yildirim M, Yazici O, Özdemir N. Retrospective Evaluation of the Efficacy of Gemcitabine-Based Therapies After FOLFIRINOX Failure in Advanced Pancreatic Cancer, Multi-Center Real-Life Data. Pancreas 2023; 52:e235-e240. [PMID: 37816170 DOI: 10.1097/mpa.0000000000002238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
OBJECTIVE Combination therapies such as FOLFIRINOX or gemcitabine-nanoparticle albumin-bound paclitaxel (GnP) are recommended for the first-line treatment of patients with advanced pancreatic cancer. The purpose of this study was to evaluate the efficacy of gemcitabine-based second-line therapies in patients whose disease progressed on FOLFIRINOX. METHOD Patients diagnosed with advanced pancreatic cancer in 7 tertiary hospitals in Turkey were included. Patients were divided into 3 different groups according to their treatment regimens: GnP, gemcitabine doublet (gemcitabine-cisplatin or gemcitabine-capecitabine), and gemcitabine monotherapy. RESULTS A total of 144 patients were included in the study. In the second-line treatment, 65% of patients were given GnP, 20% were given gemcitabine doublet, and 15% were given gemcitabine monotherapy. The median exposure of the patients to gemcitabine-based therapy was 3 cycles, whereas the median progression-free survival was calculated as 3.4 months. The median overall survival for patients who received GnP was 4.6 months, 6.4 months for patients who received gemcitabine doublet therapy, and 3.7 months for patients who received gemcitabine monotherapy ( P = 0.248). CONCLUSION In conclusion, it has been shown that gemcitabine-based second-line treatments contribute to survival in patients with advanced pancreatic cancer. In addition, there was no difference in efficacy between gemcitabine monotherapy or combination treatments.
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Affiliation(s)
- Osman Sütcüoğlu
- From the Department of Medical Oncology, Gazi University, Ankara
| | - Akif Doğan
- Department of Medical Oncology, Kartal Dr. Lütfi Kirdar City Hospital, İstanbul
| | - Funda Yilmaz
- Department of Medical Oncology, Dr. Abdurrahman Yurtarslan Oncology Training and Research Hospital, Ankara
| | | | | | | | - Cihan Erol
- Department of Medical Oncology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Aytuğ Üner
- From the Department of Medical Oncology, Gazi University, Ankara
| | - Ahmet Özet
- From the Department of Medical Oncology, Gazi University, Ankara
| | - Nedim Turan
- Department of Medical Oncology, Kartal Dr. Lütfi Kirdar City Hospital, İstanbul
| | - Emrah Eraslan
- Department of Medical Oncology, Dr. Abdurrahman Yurtarslan Oncology Training and Research Hospital, Ankara
| | - Adem Deligönül
- Department of Medical Oncology, Uludağ University, Bursa
| | - Hatice Odabaş
- Department of Medical Oncology, Kartal Dr. Lütfi Kirdar City Hospital, İstanbul
| | - Nazan Günel
- From the Department of Medical Oncology, Gazi University, Ankara
| | - Gökhan Uçar
- Department of Medical Oncology, Ankara City Hospital
| | - Didem Şener Dede
- Department of Medical Oncology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ömer Dizdar
- Department of Medical Oncology, Hacettepe University
| | - Erdem Çubukçu
- Department of Medical Oncology, Uludağ University, Bursa
| | - Ömür Berna Öksüzoğlu
- Department of Medical Oncology, Dr. Abdurrahman Yurtarslan Oncology Training and Research Hospital, Ankara
| | | | - Ozan Yazici
- From the Department of Medical Oncology, Gazi University, Ankara
| | - Nuriye Özdemir
- From the Department of Medical Oncology, Gazi University, Ankara
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