Use of gemcitabine and nab-paclitaxel as a third-line treatment following failure of first line gemcitabine for advanced pancreatic adenocarcinoma

Abstract

Introduction: First line treatment for advanced pancreatic adenocarcinoma is well documented and typically involves therapy with FOLFIRINOX or gemcitabine plus nab-paclitaxel. The CONKO-003 trial demonstrated efficacy of 2nd line treatment with the OFF regimen (oxaliplatin, 5-fluorouracil and folinic acid) and more recently the phase III trial, NAPOLI-1, established a tolerable and effective 2nd line treatment option, combining nal-irinotecan with 5-fluorouracil and leucovorin. Despite these advances, there remains minimal amount of data regarding the options for or the efficacy of 3rd line treatment in these patients. This retrospective analysis assessed the use of gemcitabine plus nab-paclitaxel as a 3rd line treatment option in a single hospital settling. Methods: Using an electronic database, we conducted a retrospective analysis of 20 patients with locally advanced or metastatic adenocarcinoma of the pancreas who received third line treatment with gemcitabine and nab-paclitaxel between 2013 and 2017. We selected patients who had received first line gemcitabine-based therapy, to assess the subsequent outcome of retreatment with gemcitabine and nab-paclitaxel (800 mg/m2 and 125 mg/m2 respectively, on days 1, 8 and 15 every four weeks). Overall survival (OS) was estimated by the Kaplan-Meier method. Results: Twenty patients were reviewed. Median age was 70 years (range, 44 - 81). 55% of the patients were females. Majority of the studied patients had locally advanced cancer at diagnosis (85%). The median OS was 6.0 months (95% CI, 4.0 - 26.0) from reinitiation of gemcitabine plus nab-paclitaxel. Conclusion: This retrospective study showed that retreatment of advanced pancreatic adenocarcinoma patients with gemcitabine plus nab-paclitaxel could be a suitable third-line treatment option. In order to evaluate the actual efficacy of this third-line chemotherapy regimen, phase III trials would need to be conducted to compare gemcitabine plus nab-paclitaxel with other chemotherapeutic agents.