Summary
Background Post-progression survival (PPS) could be a confounding element in interpreting data from clinical trials of second-line chemotherapy in patients with advanced pancreatic cancer (PC) previously treated with gemcitabine (GEM) because a recent meta-analysis of oxaliplatin combination therapy showed statistical heterogeneity for overall survival (OS) but not for progression-free survival (PFS). This study aimed to improve the understanding of the impact of PPS on OS in this setting. Methods Databases were searched to identify randomized controlled trials (RCTs) in the salvage setting. We evaluated relationships between OS and PFS, PPS, and other variables. Results Totally, 17 RCTs with 3253 patients were identified. Median OS was strongly and moderately associated with median PPS and PFS, respectively (r = 0.913; p < 0.001 and 0.780; p < 0.001, respectively). The proportion of patients with good performance status was significantly associated with both PPS and PFS (r = 0.574, p < 0.001 and 0.492, p < 0.001, respectively). The induction rate of subsequent chemotherapy was related to the duration of PPS and OS (r = 0.640, p < 0.001 and 0.647, p < 0.001, respectively). Median PPS and OS were significantly longer in recent trials than those in older trials (3.55 versus 2.78 months, p < 0.001 and 6.29 versus 5.02 months, p < 0.001). Conclusions Median PPS was strongly correlated with median OS. Given the recently increased opportunity for subsequent chemotherapy and supportive care, PPS may serve as an important element to clarify problems in this setting.
Similar content being viewed by others
References
Malvezzi M, Carioli G, Bertuccio P, Boffetta P, Levi F, La Vecchia C, Negri E (2017) European cancer mortality predictions for the year 2017, with focus on lung cancer. Annals of Oncology : Official Journal of the European Society for Medical Oncology / ESMO 28(5):1117–1123. https://doi.org/10.1093/annonc/mdx033
Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30. https://doi.org/10.3322/caac.21332
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90. https://doi.org/10.3322/caac.20107
Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, Seay T, Tjulandin SA, Ma WW, Saleh MN, Harris M, Reni M, Dowden S, Laheru D, Bahary N, Ramanathan RK, Tabernero J, Hidalgo M, Goldstein D, Van Cutsem E, Wei X, Iglesias J, Renschler MF (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369(18):1691–1703. https://doi.org/10.1056/NEJMoa1304369
Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardiere C, Bennouna J, Bachet JB, Khemissa-Akouz F, Pere-Verge D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364 (19):1817–1825. doi:https://doi.org/10.1056/NEJMoa1011923
Kasuga A, Hamamoto Y, Takeuchi A, Kawasaki K, Suzuki T, Hirata K, Sukawa Y, Takaishi H, Kanai T (2017) Positive relationship between subsequent chemotherapy and overall survival in pancreatic cancer: meta-analysis of postprogression survival for first-line chemotherapy. Cancer Chemother Pharmacol 79(3):595–602. https://doi.org/10.1007/s00280-017-3263-3
Kawakami H, Okamoto I, Hayashi H, Taguri M, Morita S, Nakagawa K (2013) Postprogression survival for first-line chemotherapy in patients with advanced gastric cancer. Eur J Cancer (Oxford, England : 1990) 49(14):3003–3009. https://doi.org/10.1016/j.ejca.2013.05.022
Terashima T, Yamashita T, Takata N, Nakagawa H, Toyama T, Arai K, Kitamura K, Yamashita T, Sakai Y, Mizukoshi E, Honda M, Kaneko S (2016) Post-progression survival and progression-free survival in patients with advanced hepatocellular carcinoma treated by sorafenib. Hepatology Research : the Official Journal of the Japan Society of Hepatology 46(7):650–656. https://doi.org/10.1111/hepr.12601
Petrelli F, Barni S (2013) Correlation of progression-free and post-progression survival with overall survival in advanced colorectal cancer. Annals of Oncology : Official Journal of the European Society for Medical Oncology / ESMO 24(1):186–192. https://doi.org/10.1093/annonc/mds289
Pelzer U, Schwaner I, Stieler J, Adler M, Seraphin J, Dorken B, Riess H, Oettle H (2011) Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: a phase III-study from the German CONKO-study group. Eur J Cancer (Oxford, England : 1990) 47(11):1676–1681. https://doi.org/10.1016/j.ejca.2011.04.011
Wang-Gillam A, Li C-P, Bodoky G, Dean A, Shan Y-S, Jameson G, Macarulla T, Lee K-H, Cunningham D, Blanc JF, Hubner RA, Chiu C-F, Schwartsmann G, Siveke JT, Braiteh F, Moyo V, Belanger B, Dhindsa N, Bayever E, Von Hoff DD, Chen L-T (2016) Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet 387(10018):545–557. https://doi.org/10.1016/s0140-6736(15)00986-1
Oettle H, Riess H, Stieler JM, Heil G, Schwaner I, Seraphin J, Gorner M, Molle M, Greten TF, Lakner V, Bischoff S, Sinn M, Dorken B, Pelzer U (2014) Second-line oxaliplatin, folinic acid, and fluorouracil versus folinic acid and fluorouracil alone for gemcitabine-refractory pancreatic cancer: outcomes from the CONKO-003 trial. J Clin Oncol Off J Am Soc Clin Oncol 32(23):2423–2429. https://doi.org/10.1200/jco.2013.53.6995
Gill S, Ko YJ, Cripps C, Beaudoin A, Dhesy-Thind S, Zulfiqar M, Zalewski P, Do T, Cano P, Lam WY, Dowden S, Grassin H, Stewart J, Moore M (2016) PANCREOX: a randomized phase III study of 5-fluorouracil/Leucovorin with or without Oxaliplatin for second-line advanced pancreatic Cancer in patients who have received gemcitabine-based chemotherapy. J Clin Oncol Off J Am Soc Clin Oncol 34:3914–3920. https://doi.org/10.1200/JCO.2016.68.5776
Ohkawa S, Okusaka T, Isayama H, Fukutomi A, Yamaguchi K, Ikeda M, Funakoshi A, Nagase M, Hamamoto Y, Nakamori S, Tsuchiya Y, Baba H, Ishii H, Omuro Y, Sho M, Matsumoto S, Yamada N, Yanagimoto H, Unno M, Ichikawa Y, Takahashi S, Watanabe G, Wakabayashi G, Egawa N, Tsuda M, Hosotani R, Hamada C, Hyodo I (2015) Randomised phase II trial of S-1 plus oxaliplatin vs S-1 in patients with gemcitabine-refractory pancreatic cancer. Br J Cancer 112(9):1428–1434. https://doi.org/10.1038/bjc.2015.103
Sonbol MB, Firwana B, Wang Z, Almader-Douglas D, Borad MJ, Makhoul I, Ramanathan RK, Ahn DH, Bekaii-Saab T (2017) Second-line treatment in patients with pancreatic ductal adenocarcinoma: a meta-analysis. Cancer 123:4680–4686. https://doi.org/10.1002/cncr.30927
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clinical research ed) 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557
Saad ED, Katz A, Buyse M (2010) Overall survival and post-progression survival in advanced breast cancer: a review of recent randomized clinical trials. J Clin Oncol Off J Am Soc Clin Oncol 28(11):1958–1962. https://doi.org/10.1200/jco.2009.25.5414
Hayashi H, Okamoto I, Morita S, Taguri M, Nakagawa K (2012) Postprogression survival for first-line chemotherapy of patients with advanced non-small-cell lung cancer. Annals of Oncology : Official Journal of the European Society for Medical Oncology / ESMO 23(6):1537–1541. https://doi.org/10.1093/annonc/mdr487
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188
Ulrich-Pur H, Raderer M, Verena Kornek G, Schull B, Schmid K, Haider K, Kwasny W, Depisch D, Schneeweiss B, Lang F, Scheithauer W (2003) Irinotecan plus raltitrexed vs raltitrexed alone in patients with gemcitabine-pretreated advanced pancreatic adenocarcinoma. Br J Cancer 88(8):1180–1184. https://doi.org/10.1038/sj.bjc.6600883
Jacobs AD, Burris HA, Rivkin S, Ritch PS, Eisenberg PD, Mettinger KL (2004) A randomized phase III study of rubitecan (ORA) vs. best choice (BC) in 409 patients with refractory pancreatic cancer report from a north-American multi-center study. J Clin Oncol 22(14_suppl):4013–4013. https://doi.org/10.1200/jco.2004.22.14_suppl.4013
Yoo C, Hwang JY, Kim JE, Kim TW, Lee JS, Park DH, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ, Kim SC, Lee JL (2009) A randomised phase II study of modified FOLFIRI.3 vs modified FOLFOX as second-line therapy in patients with gemcitabine-refractory advanced pancreatic cancer. Br J Cancer 101(10):1658–1663. https://doi.org/10.1038/sj.bjc.6605374
Ioka T, Katayama K, Ishida N, Takada R, Yamai T, Fukutake N, Ashida R, Uehara H, Ohigashi H, Takahashi H, Ishikawa O (2013) Randomized phase II study of best available fluoropyrimidine compared with continuation of gemcitabine (gem) monotherapy in patients with gem-refractory pancreatic cancer. J Clin Oncol 31(4_suppl):287–287. https://doi.org/10.1200/jco.2013.31.4_suppl.287
oral presentations (2010). Annals of Oncology 21(suppl_6):vi11–vi19. https://doi.org/10.1093/annonc/mdq268
Ioka T, Komatsu Y, Mizuno N, Tsuji A, Ohkawa S, Tanaka M, Iguchi H, Ishiguro A, Kitano M, Satoh T, Yamaguchi T, Takeda K, Kida M, Eguchi K, Ito T, Munakata M, Itoi T, Furuse J, Hamada C, Sakata Y (2017) Randomised phase II trial of irinotecan plus S-1 in patients with gemcitabine-refractory pancreatic cancer. Br J Cancer 116(4):464–471. https://doi.org/10.1038/bjc.2016.436
Wang M, Shi SB, Qi JL, Tang XY, Tian J (2013) S-1 plus CIK as second-line treatment for advanced pancreatic cancer. Med Oncol 30(4):747. https://doi.org/10.1007/s12032-013-0747-9
Ueno M, Okusaka T, Omuro Y, Isayama H, Fukutomi A, Ikeda M, Mizuno N, Fukuzawa K, Furukawa M, Iguchi H, Sugimori K, Furuse J, Shimada K, Ioka T, Nakamori S, Baba H, Komatsu Y, Takeuchi M, Hyodo I, Boku N (2016) A randomized phase II study of S-1 plus oral leucovorin versus S-1 monotherapy in patients with gemcitabine-refractory advanced pancreatic cancer. Annals of Oncology : Official Journal of the European Society for Medical Oncology / ESMO 27(3):502–508. https://doi.org/10.1093/annonc/mdv603
Ge F, Xu N, Bai Y, Ba Y, Zhang Y, Li F, Xu H, Jia R, Wang Y, Lin L, Xu J (2014) S-1 as monotherapy or in combination with leucovorin as second-line treatment in gemcitabine-refractory advanced pancreatic cancer: a randomized, open-label, multicenter, phase II study. Oncologist 19(11):1133–1134. https://doi.org/10.1634/theoncologist.2014-0223
Hurwitz HI, Uppal N, Wagner SA, Bendell JC, Beck JT, Wade SM 3rd, Nemunaitis JJ, Stella PJ, Pipas JM, Wainberg ZA, Manges R, Garrett WM, Hunter DS, Clark J, Leopold L, Sandor V, Levy RS (2015) Randomized, double-blind, phase II study of Ruxolitinib or placebo in combination with Capecitabine in patients with metastatic pancreatic Cancer for whom therapy with gemcitabine has failed. J Clin Oncol Off J Am Soc Clin Oncol 33(34):4039–4047. https://doi.org/10.1200/JCO.2015.61.4578
Chung V, McDonough S, Philip PA, Cardin D, Wang-Gillam A, Hui L, Tejani MA, Seery TE, Dy IA, Al Baghdadi T, Hendifar AE, Doyle LA, Lowy AM, Guthrie KA, Blanke CD, Hochster HS (2017) Effect of Selumetinib and MK-2206 vs Oxaliplatin and fluorouracil in patients with metastatic pancreatic Cancer after prior therapy: SWOG S1115 study randomized clinical trial. JAMA Oncology 3(4):516–522. https://doi.org/10.1001/jamaoncol.2016.5383
Ueno M, Ohkawa S, Kobayashi N, Sugimori K, Kawaguchi Y, Kobayashi S, Taguri M, Yamanaka T, Mine T (2017) Randomized phase II study of S-1 monotherapy versus gemcitabine plus S-1 in gemcitabine-refractory advanced pancreatic cancer. J Clin Oncol 35(4_suppl):429–429. https://doi.org/10.1200/JCO.2017.35.4_suppl.429
Ueno M, Ioka T, Ueno H, Park JO, Chang H-M, Sasahira N, Kanai M, Chung I-J, Ikeda M, Nakamori S, Mizuno N, Omuro Y, Yamaguchi T, Hara H, Sugimori K, Furuse J, Takeuchi M, Okusaka T, Boku N, Hyodo I (2017) TAS-118 (S-1 plus leucovorin) versus S-1 in gemcitabine-refractory advanced pancreatic cancer: A randomized, open-label, phase III trial (GRAPE trial). J Clin Oncol 35(15_suppl):4099–4099. https://doi.org/10.1200/JCO.2017.35.15_suppl.4099
Hurwitz H, Van Cutsem E, Bendell J, Hidalgo M, Li CP, Salvo MG, Macarulla T, Sahai V, Sama A, Greeno E, Yu KH, Verslype C, Dawkins F, Walker C, Clark J, O'Reilly EM (2018) Ruxolitinib + capecitabine in advanced/metastatic pancreatic cancer after disease progression/intolerance to first-line therapy: JANUS 1 and 2 randomized phase III studies. Investig New Drugs. https://doi.org/10.1007/s10637-018-0580-2
Kasuga A, Okano N, Naruge D, Kitamura H, Takasu A, Nagashima F, Furuse J (2015) Retrospective analysis of fixed dose rate infusion of gemcitabine and S-1 combination therapy (FGS) as salvage chemotherapy in patients with gemcitabine-refractory advanced pancreatic cancer: inflammation-based prognostic score predicts survival. Cancer Chemother Pharmacol 75(3):457–464. https://doi.org/10.1007/s00280-014-2665-8
Sinn M, Dalken L, Striefler JK, Bischoff S, Schweitzer N, Pelzer U, Dorken B, Riess H, Stieler JM (2016) Second-line treatment in pancreatic Cancer patients: who profits?--results from the CONKO study group. Pancreas 45(4):601–605. https://doi.org/10.1097/mpa.0000000000000533
Vienot A, Beinse G, Louvet C, de Mestier L, Meurisse A, Fein F, Heyd B, Cleau D, d'Engremont C, Dupont-Gossart AC, Lakkis Z, Tournigand C, Bouche O, Rousseau B, Neuzillet C, Bonnetain F, Borg C, Vernerey D (2017) Overall survival prediction and usefulness of second-line chemotherapy in advanced pancreatic adenocarcinoma. J Natl Cancer Inst 109(10). https://doi.org/10.1093/jnci/djx037
Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495. https://doi.org/10.1016/s1470-2045(10)70218-7
Ouyang H, Ma W, Liu F, Yue Z, Fang M, Quan M, Pan Z (2017) Factors influencing survival of patients with pancreatic adenocarcinoma and synchronous liver metastases receiving palliative care. Pancreatology : Official Journal of the International Association of Pancreatology 17(5):773–781. https://doi.org/10.1016/j.pan.2017.07.002
Iino C, Shimoyama T, Igarashi T, Aihara T, Ishii K, Sakamoto J, Tono H, Fukuda S (2017) Biliary drainage improves the predictive value of modified Glasgow prognostic scores in inoperable pancreatic cancer. PLoS One 12(6):e0178777. https://doi.org/10.1371/journal.pone.0178777
Hayashi H, Okamoto I, Taguri M, Morita S, Nakagawa K (2013) Postprogression survival in patients with advanced non-small-cell lung cancer who receive second-line or third-line chemotherapy. Clin Lung Cancer 14(3):261–266. https://doi.org/10.1016/j.cllc.2012.09.006
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare no Conflicts of Interests for this article.
Takanori Kanai received research grants from Astellas Pharm Inc., Astra-Zeneca K.K., Otsuka Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd., Eisai Pharmaceutical Co. Ltd., Zeria Pharmaceutical Co. Ltd., Tanabe Mitsubishi Pharmaceutical Co. Ltd., JIMRO Co. Ltd., Kyorin Pharmaceutical Co. Ltd., and received service honoraria from Astellas Pharm Inc., Eisai Pharmaceutical Co. Ltd., JIMRO Co. Ltd., Tanabe Mitsubishi Pharmaceutical Co. Ltd., Otsuka Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd., Miyarisan Pharmaceutical Co. Ltd., and Zeria Pharmaceutical Co. Ltd. Hiromasa Takaishi received research grants from Taiho Pharmaceutical Co. Ltd., and Yakult Honsha Pharmaceutical Co. Ltd., outside the submitted work.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
We did not use individual data but published data. These data have been widely utilized in research and are generally available. Therefore, we confirm that any aspect of the work covered in this manuscript has been conducted with ethical approval. And this study is registered in the PROSPERO database (CRD42017071274) and was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) statement.
Rights and permissions
About this article
Cite this article
Kasuga, A., Hamamoto, Y., Takeuchi, A. et al. Post-progression survival following second-line chemotherapy in patients with advanced pancreatic cancer previously treated with gemcitabine: a meta-analysis. Invest New Drugs 36, 939–948 (2018). https://doi.org/10.1007/s10637-018-0589-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10637-018-0589-6