Second-Line Therapy Outcomes in Metastatic Pancreatic Cancer

A study published in ESMO Open evaluated outcomes of second-line chemotherapy combinations for patients with metastatic pancreatic cancer who had failed on first-line treatments.

“There is no clear consensus on the recommended second-line treatment for patients with metastatic pancreatic cancer who have disease progression following gemcitabine-based therapy,” wrote the study authors.

This retrospective study, conducted by the Korean Cancer Study Group, enrolled 378 patients with metastatic pancreatic cancer who previously received gemcitabine-based chemotherapy. Between 2015 and 2019, patients received treatment with either liposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin (FL; n = 104) or FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin; n = 274). Treatment was continued until disease progression or intolerable toxicity. Primary outcomes included progression-free survival (PFS) and overall survival (OS) after a median follow-up of six months.

For patients who received the nal-IRI plus FL, median PFS was 3.7 months and median OS was 7.7 months. Patients treated with the FOLFIRINOX regimen achieved a median PFS of 4.6 months and median OS of 9.7 months. Univariate and multivariate analysis found no significant differences in survival between the treatment groups. Upon subgroup analysis, older age (≥ 70 years) was associated with improved survival compared to younger patients in the nal-IRI group, while the opposite was true for the FOLFIRINOX cohort.

Both groups experienced manageable adverse events, although the incidence of grade 3 or higher neutropenia and peripheral neuropathy was higher in the FOLFIRINOX cohort compared to the nal-IRI cohort.

In conclusion the authors wrote, “Second-line nal-IRI/FL and FOLFIRINOX showed similar effectiveness outcomes after progression following first-line gemcitabine-based therapy. Age could be the determining factor for choosing the appropriate second-line therapy.”