Journal of the Formosan Medical Association最新文献

Background/objective: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with limited later-line therapeutic options. This retrospective study aimed to evaluate the efficacy and safety of platinum-based chemotherapy as third-line treatment for metastatic PDAC.

Methods: We analyzed 102 patients who received third-line systemic treatment for PDAC between 2018 and 2023 across five medical centers in Taiwan. All patients had previously received first-line gemcitabine-based therapy and second-line nanoliposomal irinotecan with 5-fluorouracil and leucovorin. Overall, one group (N = 40) received platinum-based regimens, whereas the other group (N = 62) received non-platinum-based treatments. Survival outcomes and treatment-related toxicities were compared between the groups.

Results: The median overall survival (OS) duration was 5.8 months (95 % CI, 3.3-8.3) for the platinum group and 4.3 months (95 % CI, 3.5-5.0) for the non-platinum group, without a statistically significant difference (HR, 0.74, 95 % CI: 0.46-1.18, p = 0.21). The median time-to-treatment failure was 2.4 months (95 % CI, 1.6-3.2) and 2.1 months (95 % CI, 1.3-2.9), respectively (HR, 0.85, 95 % CI: 0.57-1.28, p = 0.44). Subgroup analyses suggested that younger age and no history of pancreatectomy tended to associate with better OS following platinum-based treatment. However, the platinum group experienced a higher incidence aspartate aminotransferase elevation (13 % vs. 2 %, p = 0.033) and increased creatinine (13 % vs. 2 %, p = 0.033) levels than the non-platinum group.

Conclusions: This study showed that a platinum-based third-line chemotherapy regimen for patients with metastatic PDAC did not confer a significant survival advantage over non-platinum-based regimens. Platinum-based regimens are associated with modestly increased treatment-related toxicities, thus potentially limiting their tolerability in these heavily pretreated patients.

Background: Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm characterized by sustained thrombocytosis and an elevated risk of thrombotic events. Despite growing clinical relevance, population-based data on ET incidence, prevalence, treatment patterns, and sex-specific differences remain limited in Asia.

Objectives: To evaluate the epidemiologic trends, treatment patterns, and sex-based differences in ET patients in Taiwan from 2017 to 2021, using a nationwide administrative database.

Methods: This retrospective, population-based study utilized the Taiwan National Health Insurance Research Database to identify newly diagnosed ET patients between 2017 and 2021. Case identification was based on ICD-10-CM code D47.3, with confirmation via two or more coded visits at least 90 days apart. Patients were stratified by sex and treatment regimen, including observation, anti-platelet (anti-PLT) monotherapy, hydroxyurea monotherapy, anagrelide monotherapy, or HU + ANA combination therapy. Trends in incidence, prevalence, medication exposure, thrombosis, myelofibrosis, and mortality were analyzed.

Results: A total of 3776 new ET cases were identified (60 % female). Incidence rates remained stable from 2017 to 2020, followed by a sharp decline in 2021. Prevalence steadily increased in both sexes, with consistently higher rates in females. Medication patterns showed rising use of watchful waiting and declining anagrelide use over time. Patients prescribed hydroxyurea demonstrated reduced thrombosis risk compared to those who received only anti-PLT therapy.

Conclusions: This population-based study highlights increasing ET prevalence and evolving treatment patterns in Taiwan, with tentative sex-based differences in age distribution and therapeutic response. Findings underscore the need for individualized, risk-adapted management and support ongoing surveillance to inform policy and clinical practice in Asian populations.