Second-line treatment feasible for advanced pancreatic cancer
medwireNews: Second-line therapy is supported for patients with metastatic pancreatic cancer, with fluoropyrimidine-containing regimens providing substantial benefits.
Historically, treatment plans for advanced pancreatic cancer have tended to comprise just one line of therapy, perhaps due to the aggressive nature of the disease and lack of effective treatment options, explain the researchers.
But newer therapies with improved efficacies suggest greater opportunities for second-line treatment, a contention borne out by this post hoc analysis of the phase III MPACT trial, which evaluated nab-paclitaxel plus gemcitabine versus gemcitabine monotherapy in the first-line setting.
Altogether, median total overall survival (OS; from randomisation to first-line therapy) was longer for the 347 patients who went on to receive second-line therapy than for the 476 who did not, at 10.9 versus 5.4 months.
And, as reported in the British Journal of Cancer, receipt of second-line therapy was one of the factors significantly associated with improved survival after first-line treatment.
Patients derived greater benefits from second-line regimens with versus without fluoropyrimidine, with median total OS of 13.5 and 10.9 months, respectively.
The longest median total OS in this analysis was seen with second-line FOLFIRINOX, given after nab-paclitaxel plus gemcitabine, at 15.7 months. However, the authors caution that FOLFIRINOX treatment was limited to patients with favourable features, “making it difficult to determine how much of the longer survival was due to the efficacy of FOLFIRINOX vs inherent patient factors”.
Our results “support the increasing use” of second-line therapy in this patient population, emphasize E Gabriela Chiorean (University of Washington, Seattle, USA) and team.
They add: “Further guidance for the use of [second-line] therapy will depend on enhanced identification of biologic predictors of [second-line] treatment benefit, development of more active regimens, and a better understanding of how an effective [first-line] therapy may influence clinical benefit in subsequent treatments.”
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