Second-line treatment in patients with pancreatic ductal adenocarcinoma: A meta-analysis

Mohamad Bassam Sonbol, Belal Firwana, Zhen Wang, Diana Almader-Douglas, Mitesh J Borad, Issam Makhoul, Ramesk K Ramanathan, Daniel Ahn, Tanios Bekaii-Saab

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

BACKGROUND: There are limited therapeutic options for treatment-refractory pancreatic ductal adenocarcinoma (PDAC), with a paucity of data to support the best option after progression on gemcitabine-based regimens. The authors performed a meta-analysis to determine the effectiveness of adding oxaliplatin (OX) or various irinotecan formulations to a fluoropyrimidine (FP) after first-line treatment progression in patients with PDAC. METHODS: Different databases, including PubMed, EMBASE, and Cochrane, were searched to identify randomized controlled trials comparing FP monotherapy versus FP combination therapy that included either oxaliplatin (FPOX) or various irinotecan formulations (FPIRI) in patients with PDAC who progressed after first-line treatment. Secondary analyses were planned to assess the effectiveness of FPOX and FPIRI compared with FP. Outcomes of interest included overall survival (OS) and progression-free survival (PFS). RESULTS: Five studies with 895 patients were identified. Patients randomized to receive FPIRI/FPOX had a significantly improved PFS and a trend toward improved OS compared with those who received FP monotherapy. When comparing FPIRI with FP, there was an improvement in both PFS (hazard ratio, 0.64; 95% confidence interval, 0.47-0.87; P =.005) and OS (hazard ratio, 0.70; 95% confidence interval, 0.55-0.89; P =.004) in patients who received the combination. Conversely, FPOX produced only a modest improvement in PFS with no improvement in OS. CONCLUSIONS: Combination chemotherapy with OX or various IRI formulations appears to improve PFS compared with single-agent FP. FPIRI, but not FPOX, appears to confer an OS advantage. The combination of FP with irinotecan formulations appears to be the appropriate next line of treatment upon progression after gemcitabine-based chemotherapy regimens. Cancer 2017;123:4680-4686.

Original languageEnglish (US)
Pages (from-to)4680-4686
Number of pages7
JournalCancer
Volume123
Issue number23
DOIs
StatePublished - Dec 1 2017

Keywords

  • folinic acid, fluorouracil, and oxaliplatin (FOLFOX)
  • nanoliposomal irinotecan
  • pancreatic adenocarcinoma
  • pancreatic cancer
  • second-line treatment

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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