Gemcitabine as second-line chemotherapy after Folfirinox failure in advanced pancreatic adenocarcinoma: A retrospective study

Juliette Viaud (1) , Clémence Brac (2) , Pascal Artru (3) , Estelle Le Pabic (1, 4) , Bérengère Leconte (1) , Anaïs Bodere (1) , Marc Pracht (2) , Samuel Le Sourd (2) , Julien Edeline (2) , Astrid Lièvre (5, 1, 6)

1 CHU Pontchaillou [Rennes]
2 Service d'oncologie médicale
3 Hôpital privé Jean Mermoz
4 CIC - Centre d'Investigation Clinique [Rennes]
5 Service des Maladies de l'Appareil Digestif [CHU Rennes]
6 COSS - Chemistry, Oncogenesis, Stress and Signaling

BACKGROUND: Pancreatic adenocarcinoma (PA) is diagnosed in most cases at an advanced stage requiring chemotherapy. Folfirinox is the standard first-line treatment. After Folfirinox failure, gemcitabine alone is routinely used as second-line therapy without data supporting this attitude.AIM: Determine the response rate and outcome of patients with advanced PA treated with gemcitabine after Folfirinox failure.METHODS: We retrospectively analyzed all consecutive patients treated with gemcitabine after Folfirinox failure for a locally advanced or metastatic PA between 2009 and 2015. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Response rate, control rate and tolerability were assessed.RESULTS: 96 patients were included (male, 51%; median age, 62; performance status (PS) 0-1, 47%). Median duration on gemcitabine was 2.1 months. The overall disease control rate was 40%. Median OS was 3.7 months (95%CI: 2.5-5.2) and median PFS was 2.1 months (95%CI: 2.0-2.6). Reasons for treatment discontinuation were mostly progression (51%). Age at diagnosis and PS were independently associated with OS in multivariate analysis (HR of 1.86; p=0.0055 and 2.42; p<0.0001 respectively). 34 patients experienced a grade 3 adverse event.CONCLUSIONS: This study suggests that gemcitabine is not beneficial to all patients failing on Folfirinox first-line therapy and should be restricted to young patients with good PS.

Keywords: Folfirinox; Advanced pancreatic cancer; gemcitabine; second-line chemotherapy

Domains: Life Sciences [q-bio]; Pharmaceutical sciences; Medication; Life Sciences [q-bio]; Cancer; Life Sciences [q-bio]; Human health and pathology; Hépatology and Gastroenterology

Juliette Viaud, Clémence Brac, Pascal Artru, Estelle Le Pabic, Bérengère Leconte, et al.. Gemcitabine as second-line chemotherapy after Folfirinox failure in advanced pancreatic adenocarcinoma: A retrospective study. Digestive and Liver Disease, 2017, 49 (6), pp.692-696. ⟨10.1016/j.dld.2017.02.007⟩. ⟨hal-01534249⟩