Prognostic analysis and outcomes of metastatic pancreatic cancer patients receiving nab-paclitaxel plus gemcitabine as second or later-line treatment.

Autor: Giordano G; Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy., Milella M; Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy., Landriscina M; Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy., Bergamo F; Department of Oncology, Veneto Institute of Oncology IRCCS, Padova, Italy., Tirino G; Unit of Medical Oncology, Sacro Cuore di Gesu'-Fatebenefratelli Hospital, Benevento, Italy., Santaniello A; Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy., Zaniboni A; Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy., Vasile E; Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., De Vita F; Division of Medical Oncology, Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy., Re GL; Medical Oncology and Immune-Related Tumors, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy., Vaccaro V; Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy., Giommoni E; Medical Oncology Unit, Careggi University Hospital, Florence, Italy., Natale D; Ospedale San Massimo, Penne, Italy., Conca R; Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy., Santini D; Medical Oncology A, University of Rome, Policlinico Umberto I, 'La Sapienza, Rome, Italy., Maiorino L; Medical Oncology Unit, San Gennaro Hospital, Naples, Italy., Sanna G; Medical Oncology, Istituto Ospedaliero dell'Università di Sassari, Sassari, Italy., Ricci V; Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale 'San Pio', Benevento, Italy., Iop A; Department of Oncology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy., Montesarchio V; Oncology Unit-A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy., Procaccio L; Department of Oncology, Veneto Institute of Oncology IRCCS, Padova, Italy., Noventa S; Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy., Bianco R; Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy., Febbraro A; Unit of Medical Oncology, Sacro Cuore di Gesu'-Fatebenefratelli Hospital, Benevento, Italy., Lonardi S; Department of Oncology, Veneto Institute of Oncology IRCCS, Padova, Italy., Tortora G; Oncologia Medica, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy.; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy., Sperduti I; Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri, Rome, Italy., Melisi D; Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.; Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.; Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.
Jazyk: angličtina
Zdroj: Cancer medicine [Cancer Med] 2024 Jun; Vol. 13 (12), pp. e7345.
DOI: 10.1002/cam4.7345
Abstrakt: 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.
(© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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