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Background <p>This study aimed to compare the benefits and identify the best second-line treatment regimen for gemcitabine-refractory unresectable pancreatic cancers.</p> Patients and methods <p>This retrospective analysis included 144 patients with unresectable pancreatic cancer who underwent a gemcitabine-based regimen as the first-line treatment. 57, 37, and 50 patients received oxaliplatin-, irinotecan-based, and modified FOLFIRINOX (mFFX) regimens, respectively. The primary endpoint of this study was progression-free survival (PFS) and the secondary endpoints were overall survival (OS), response rate, and treatment-related toxicity.</p> Results <p>There were no significant differences in median PFS (mPFS) (4.6 months vs. 2.9 months, <i>P</i> = 0.627, HR = 1.128, 95%CI 0.693–1.836) and median OS (mOS) (6.5 months vs. 10.2 months, <i>P</i> = 0.108, HR = 0.664, 95%CI 0.392–1.125) between irinotecan- and oxaliplatin-based groups. The mOS was significantly longer in the mFFX group than in the Iri/Oxa group (pooled the irinotecan- and oxaliplatin-based groups) (10.7 months vs. 8.8 months, <i>P</i> = 0.035, HR = 1.560, 95%CI 1.037–2.347), whereas no statistical difference was observed in mPFS between the two groups (4.4 months vs. 4.2 months, <i>P</i> = 0.222, HR = 1.247, 95%CI 0.866–1.797). However, after propensity score matching adjustment, no significant differences were found in mPFS (3.5 months vs. 4.2 months, <i>P</i> = 0.290, HR = 0.763, 95%CI 0.448–1.297) and mOS (8.5 months vs. 12.4 months, <i>P</i> = 0.464, HR = 1.262, 95%CI 0.673–2.367) between mFFX and Iri/Oxa groups. Survival analysis by performance status showed that patients with good performance status lived longer than those with poor performance status (10.8 months vs. 7.7 months, <i>P</i> = 0.000, HR = 2.194, 95%CI 1.408–3.420), suggesting that patient performance status, rather than the treatment regimen, was the primary factor affecting overall survival during second-line treatment.</p> Conclusions <p>In the second-line treatment of pancreatic cancer, the efficacy of common treatment regimens is not significantly different, while a good performance status is the key factor influencing survival. Thus, it is recommended that supportive care be enhanced concurrently with systemic therapy in patients with pancreatic cancer.</p>

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Efficacy of second-line treatment for gemcitabine-refractory unresectable pancreatic cancer in a real-world setting

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月24日

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  • Qianqian Wang,
  • Nan Lv,
  • Dong Xu,
  • Yang Wu,
  • Junli Wu,
  • Wentao Gao,
  • Jishu Wei,
  • Bin Xiao,
  • Min Tu,
  • Kuirong Jiang

摘要

Background

This study aimed to compare the benefits and identify the best second-line treatment regimen for gemcitabine-refractory unresectable pancreatic cancers.

Patients and methods

This retrospective analysis included 144 patients with unresectable pancreatic cancer who underwent a gemcitabine-based regimen as the first-line treatment. 57, 37, and 50 patients received oxaliplatin-, irinotecan-based, and modified FOLFIRINOX (mFFX) regimens, respectively. The primary endpoint of this study was progression-free survival (PFS) and the secondary endpoints were overall survival (OS), response rate, and treatment-related toxicity.

Results

There were no significant differences in median PFS (mPFS) (4.6 months vs. 2.9 months, P = 0.627, HR = 1.128, 95%CI 0.693–1.836) and median OS (mOS) (6.5 months vs. 10.2 months, P = 0.108, HR = 0.664, 95%CI 0.392–1.125) between irinotecan- and oxaliplatin-based groups. The mOS was significantly longer in the mFFX group than in the Iri/Oxa group (pooled the irinotecan- and oxaliplatin-based groups) (10.7 months vs. 8.8 months, P = 0.035, HR = 1.560, 95%CI 1.037–2.347), whereas no statistical difference was observed in mPFS between the two groups (4.4 months vs. 4.2 months, P = 0.222, HR = 1.247, 95%CI 0.866–1.797). However, after propensity score matching adjustment, no significant differences were found in mPFS (3.5 months vs. 4.2 months, P = 0.290, HR = 0.763, 95%CI 0.448–1.297) and mOS (8.5 months vs. 12.4 months, P = 0.464, HR = 1.262, 95%CI 0.673–2.367) between mFFX and Iri/Oxa groups. Survival analysis by performance status showed that patients with good performance status lived longer than those with poor performance status (10.8 months vs. 7.7 months, P = 0.000, HR = 2.194, 95%CI 1.408–3.420), suggesting that patient performance status, rather than the treatment regimen, was the primary factor affecting overall survival during second-line treatment.

Conclusions

In the second-line treatment of pancreatic cancer, the efficacy of common treatment regimens is not significantly different, while a good performance status is the key factor influencing survival. Thus, it is recommended that supportive care be enhanced concurrently with systemic therapy in patients with pancreatic cancer.