Metastatic pancreatic cancer: second-line therapy extends survival after nab-paclitaxel + gemcitabine

  • Br J Cancer

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • The findings from this study support the use of second-line therapy for patients with metastatic pancreatic cancer.
  • Fluoropyrimidine-containing treatment after first-line nab-P+Gem is an active regimen with significant clinical effect.

Study design

  • Post hoc evaluation to assess the effect of second-line therapy of metastatic pancreatic cancer and prognostic indicators of survival after the MPACT (metastatic pancreatic cancer in a large phase 3 trial) study.
  • At the end of the MPACT trial, 45 surviving patients were followed up in an observational extension study.
  • Patients received first-line nab-paclitaxel + gemcitabine (nab-P+Gem; n=26) or gemcitabine alone (Gem; n=19); 40% of the nab-P+Gem group received second-line treatment vs 44% of the Gem group.

Key results

  • 77% of second-line treatments contained a fluoropyrimidine
  • Median total survival from first-line randomization in patients who received second-line treatment: 12.8 mo with first-line nab-P+Gem vs 9.9 mo with first-line Gem (P=.015).
  • Median total survival from second-line randomization: 5.3 mo for nab-P+Gem vs 4.5 mo with Gem (P=.886).
  • Factors significantly associated with longer post first-line survival (multivariate analysis) were first-line nab-P+Gem, any second-line therapy, longer first-line PFS, Karnofsky performance status ≥70 and neutrophil-to-lymphocyte ratio ≤5 at the end of first-linetherapy.

Limitations

  • Post hoc analysis.
  • Details of second-line therapy were not included
  • Survival outcomes do not include patient who died prior to receiving second-line therapy.

Why this matters

  • The treatment of pancreatic cancer has largely comprised only 1 line of therapy.
  • Improved survival with first-line therapy in the phase 3 MPACT study of nab-P+Gem and the PRODIGE phase 3 study of folinic acid, 5-fluoracil, irinotecan, and oxaliplatin (both vs Gem) suggest new opportunities for second-line therapy in this setting.