Cancer Treatment Today

This is second line therapy.   The most recent overview (Rahma et al) for second line therapy for pancreatic cancer showed that , although not conclusive, the advantage of second-line chemotherapy in pancreatic cancer is very limited and there is a need for more studies. Of 12 studies with combinations of 5FU, If 12 studies based on 5FU combinations,  the CONKO-003 trial was the only phase III randomized study comparing OFF (oxaliplatin, folinic acid, and 5-FU) to FF (folinic acid and 5-FU) [22].Nevertheless, there is data that supports second line therapy for some regimens and NCCN does support it.  Dbouk et al says”no standard of care has been established for a second-line therapy in advanced pancreatic cancer. The CONKO-003 study established the superiority of second-line chemotherapy with oxaliplatin, FA, and 5-FU (OFF) over best supportive care (BSC) for patients progressing while on first-line gemcitabine chemotherapy, despite the fact that the study closed early due to poor accrual. Median survival for patients treated with second-line chemotherapy was 4.82 months vs. 2.3 months with BSC alone (HR, 0.45; 95% CI, 0.240.83; P = 0.008). Small phase II and retrospective studies have evaluated various second-line therapies including nab-paclitaxel,15 gemcitabine, and cisplatin combined with regional hyperthermia,16 cisplatin plus S-1 (an oral fluoropyrimidine),17 5-FU/FA plus irinotecan (FOLFIRI),18 and GTX. Patients who progress on first-line chemotherapy with good performance status should be encouraged to enter clinical trials. If these are not available, we have randomized evidence to support the use of second-line chemotherapy. There appear to be several drugs with activity in the second-line setting, and the choice of agent depends on the first-line treatment and response. Many patients with good performance status are now being treated with the combination of 5-FU, FA, irinotecan, and oxaliplatin (FOLFIRINOX) in the first-line metastatic setting19 and may benefit from gemcitabine-based second-line combinations.”.

NCCN on Panc-G supports second line therapy . It says: “Second-line chemotherapy may consist of gemcitabine-based therapy for those previously treated with fluoropyrimidine-based therapy
, and fluoropyrimidine-based therapy for those previously treated with gemcitabine-based therapy . Results of the CONKO 003 trial demonstrated a significant improvement in overall survival with the addition of oxaliplatin to 5-FU/leucovorin.”

O. E. Rahma et al, Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials, Ann Oncol (2013) doi: 10.1093/annonc/mdt166 First published online: May 12, 2013

Haifa Dbouk et al, Modified GTX as Second-Line Chemotherapy in Advanced Pancreatic Cancer. Gastrointest Cancer Res. 2013 Jul-Aug; 6(4): 115117

NCCN, Pancreatic 2014

O. E. Rahma et al, Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials, Ann Oncol (2013) doi: 10.1093/annonc/mdt166 First published online: May 12, 2013

Haifa Dbouk et al, Modified GTX as Second-Line Chemotherapy in Advanced Pancreatic Cancer. Gastrointest Cancer Res. 2013 Jul-Aug; 6(4): 115117

NCCN, Pancreatic 2014