Second Line Chemotherapy in Patients with Advanced Pancreatic Cancer after Failure of First-Line FOLFIRINOX: A Retrospective Analysis

Background: The first-line combination chemotherapy regimens, FOLFIRINOX and gemcitabine/nab-paclitaxel, improved survival outcomes in patients with advanced pancreatic cancer. However, there is no consensus therapy after failure of first-line chemotherapy. This objective of this study was to analysis of the clinical characteristics and outcomes of subsequent chemotherapy in patients who failed first-line FOLFIRINOX. Methods: This retrospective study analyzed the clinical data of patients with advanced pancreatic cancer receiving second-line chemotherapy after failure of FOLFIRINOX at Kosin University Gaspel Hospital from January 2013 to July 2020. Results: Sixty-three patients with advanced pancreatic cancer received first-line FOLFIRINOX, and 33 (51.7%) of those patients received at least one cycle of second-line chemotherapy. At the start of second-line chemotherapy, the median age of patients was 59 years (range, 31-79), and 54.5% (61 patients) was male. The second-line chemotherapy regimens included gemcitabine/ nab-paclitaxel (21, 63.6%), gemcitabine/erlotinib (6, 18.2%), and gemcitabine monotherapy (6, 18.2%). Of twenty-five patients who had measurable disease, only 1 patient (4.0%) achieved a partial response, and the disease control rate was 56% (14 patients). The median Overall Survival (OS) was 8.7 months (95% Confidence Interval [CI], 5.2-12.2), and the median progression-free survival was 3.2 months (95% CI, 1.7-4.8). The median OS from starting FOLFIRINOX was14.7 months (95% CI, 10.4-18.3). There was no significant difference of median OS between second-line regimens. Conclusion: Gemcitabine-based chemotherapy had modest survival benefits in patients with advanced pancreatic cancer after failure of FOLFIRINOX.