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Second-Line Treatment for Advanced Pancreatic Adenocarcinoma: Is There a Role for Gemcitabine?

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Abstract

Purpose

Advanced pancreatic adenocarcinoma (PA) is an aggressive disease that has poor prognosis and frequently interferes with patient’s quality of life. There has been progress in first-line regimens; however, there is no standard second-line regimen. The aim of this study is to analyze second-line gemcitabine after first-line fluorouracil (FU) + leucovorin (LV) + irinotecan + oxaliplatin (FOLFIRINOX) regimen.

Methods

This study included consecutive patients with advanced PA treated at Hospital Sirio-Libanês from 2011 to 2016. The patients received FOLFIRINOX as first-line treatment and upon progression, received gemcitabine alone. Survival analysis was performed using the Kaplan-Meier method.

Results

A total of 54 patients were evaluated. Most patients were male (61.1%) and most had an ECOG performance status of 0 or 1 prior to the beginning of second-line treatment (66.6%). The mean number of gemcitabine cycles was 3.4. Most patients had disease progression as the best response to treatment (75.9%), 11.1% had stable disease, and 9.3% experienced a partial response. The median progression-free survival was 1.7 months, and the median overall survival was 6.8 months.

Conclusions

Gemcitabine alone did not show meaningful clinical benefit as second-line treatment after FOLFIRINOX.

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Acknowledgements

The Oncology Center of Hospital Sírio-Libanes supported this work.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Oncology, Hospital Sírio-Libanes, SGAS 613-conjunto E lote 95-Asa Sul, Brasília, DF, 70200-001, Brazil

    Daniel M. Girardi, Luiza Dib B. B. Faria, Marcela C. Teixeira, Frederico P. Costa & Gustavo S. Fernandes

  2. Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Paulo Marcelo G. Hoff

Authors
  1. Daniel M. Girardi
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  2. Luiza Dib B. B. Faria
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  3. Marcela C. Teixeira
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  4. Frederico P. Costa
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  5. Paulo Marcelo G. Hoff
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  6. Gustavo S. Fernandes
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Corresponding author

Correspondence to Daniel M. Girardi.

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Conflict of Interest

Gustavo dos Santos Fernandes has received grants for consulting or Advisory Role from Roche, has received a speaker honorarium from Roche, has provided expert testimony for Novartis, and received travel accommodations and expenses from Roche. The rest of the authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Girardi, D.M., Faria, L.D.B.B., Teixeira, M.C. et al. Second-Line Treatment for Advanced Pancreatic Adenocarcinoma: Is There a Role for Gemcitabine?. J Gastrointest Canc 50, 860–866 (2019). https://doi.org/10.1007/s12029-018-0166-4

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  • DOI: https://doi.org/10.1007/s12029-018-0166-4

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