Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic Cancer
Background: The outcome and tolerability of palliative second line chemotherapy for advanced pancreatic cancer (APC) in real life patients are largely unknown. Prognostic parameters for risk stratification and treatment guidance are lacking.Materials and Methods: A population based multicenter retro...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-07-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2020.01176/full |
| _version_ | 1818190478382727168 |
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| author | Emma Gränsmark Emma Gränsmark Emma Gränsmark Nellie Bågenholm Bylin Nellie Bågenholm Bylin Hakon Blomstrand Hakon Blomstrand Mats Fredrikson Elisabeth Åvall-Lundqvist Elisabeth Åvall-Lundqvist Nils O. Elander Nils O. Elander |
| author_facet | Emma Gränsmark Emma Gränsmark Emma Gränsmark Nellie Bågenholm Bylin Nellie Bågenholm Bylin Hakon Blomstrand Hakon Blomstrand Mats Fredrikson Elisabeth Åvall-Lundqvist Elisabeth Åvall-Lundqvist Nils O. Elander Nils O. Elander |
| author_sort | Emma Gränsmark |
| collection | DOAJ |
| description | Background: The outcome and tolerability of palliative second line chemotherapy for advanced pancreatic cancer (APC) in real life patients are largely unknown. Prognostic parameters for risk stratification and treatment guidance are lacking.Materials and Methods: A population based multicenter retrospective cohort study was conducted, covering all APC patients who received palliative second-line chemotherapy between 2011 and 2018 at any cancer center in the South East Region of Sweden. Primary outcome was overall survival after second-line therapy (OS2). Time to treatment failure after second-line therapy (TTF2), hematological toxicity, and unplanned hospitalizations were key secondary outcomes. A number of baseline potentially prognostic parameters were assessed.Results: A total of 509 patients received first-line palliative chemotherapy, and of these 167 (33%) received at least one dose of second-line therapy and formed the final study population. Median OS2 was 5.2 months (95% CI = 4.7–5.7) and median TTF2 was 1.9 months (1.5–2.2). OS2 and TTF2 were similar regardless regimen, including comparison of the two most common regimens (fluoropyrimidine monotherapy vs. fluoropyrimidine/oxaliplatin doublet). Multivariate analysis revealed that normal plasma albumin (≥35) and serum CA-19-9 above median (>1,550) were independent predictors for OS2 (HR = 0.21, p < 0.001 and HR = 2.03, p = 0.009) and TTF2 (HR = 0.22, p < 0.001 and HR = 2.03, p = 0.01), while ECOG performance status >1 was predictive for TTF2 (HR = 2.05, p = 0.032). Grade 3–4 hematological toxicity was registered in 17 patients (10%). 50 (30%) had at least one event of hospitalization.Conclusion: The real world outcome of second line palliative chemotherapy for refractory APC remains dismal. Baseline plasma albumin, serum CA-19-9, and performance status emerge as key prognostic factors, and should be further studied as tools for individualized treatment decisions. |
| first_indexed | 2024-12-11T23:59:21Z |
| format | Article |
| id | doaj.art-6ef161057ab14e81a93288784c5e2f5e |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-11T23:59:21Z |
| publishDate | 2020-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-6ef161057ab14e81a93288784c5e2f5e2022-12-22T00:45:17ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-07-011010.3389/fonc.2020.01176535550Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic CancerEmma Gränsmark0Emma Gränsmark1Emma Gränsmark2Nellie Bågenholm Bylin3Nellie Bågenholm Bylin4Hakon Blomstrand5Hakon Blomstrand6Mats Fredrikson7Elisabeth Åvall-Lundqvist8Elisabeth Åvall-Lundqvist9Nils O. Elander10Nils O. Elander11Department of Oncology, Kalmar County Hospital, Kalmar, SwedenDepartment of Oncology, Linköping University, Linköping, SwedenDepartment of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Oncology, Linköping University, Linköping, SwedenDepartment of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Clinical Pathology, Linköping University, Linköping, SwedenForum Östergötland, Linköping University, Linköping, SwedenDepartment of Oncology, Linköping University, Linköping, SwedenDepartment of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenDepartment of Oncology, Linköping University, Linköping, SwedenDepartment of Biomedical and Clinical Sciences, Linköping University, Linköping, SwedenBackground: The outcome and tolerability of palliative second line chemotherapy for advanced pancreatic cancer (APC) in real life patients are largely unknown. Prognostic parameters for risk stratification and treatment guidance are lacking.Materials and Methods: A population based multicenter retrospective cohort study was conducted, covering all APC patients who received palliative second-line chemotherapy between 2011 and 2018 at any cancer center in the South East Region of Sweden. Primary outcome was overall survival after second-line therapy (OS2). Time to treatment failure after second-line therapy (TTF2), hematological toxicity, and unplanned hospitalizations were key secondary outcomes. A number of baseline potentially prognostic parameters were assessed.Results: A total of 509 patients received first-line palliative chemotherapy, and of these 167 (33%) received at least one dose of second-line therapy and formed the final study population. Median OS2 was 5.2 months (95% CI = 4.7–5.7) and median TTF2 was 1.9 months (1.5–2.2). OS2 and TTF2 were similar regardless regimen, including comparison of the two most common regimens (fluoropyrimidine monotherapy vs. fluoropyrimidine/oxaliplatin doublet). Multivariate analysis revealed that normal plasma albumin (≥35) and serum CA-19-9 above median (>1,550) were independent predictors for OS2 (HR = 0.21, p < 0.001 and HR = 2.03, p = 0.009) and TTF2 (HR = 0.22, p < 0.001 and HR = 2.03, p = 0.01), while ECOG performance status >1 was predictive for TTF2 (HR = 2.05, p = 0.032). Grade 3–4 hematological toxicity was registered in 17 patients (10%). 50 (30%) had at least one event of hospitalization.Conclusion: The real world outcome of second line palliative chemotherapy for refractory APC remains dismal. Baseline plasma albumin, serum CA-19-9, and performance status emerge as key prognostic factors, and should be further studied as tools for individualized treatment decisions.https://www.frontiersin.org/article/10.3389/fonc.2020.01176/fullpancreatic cancerpalliative therapycancer chemotherapyprognostic factorsCA-19-9 antigenhuman plasma albumin |
| spellingShingle | Emma Gränsmark Emma Gränsmark Emma Gränsmark Nellie Bågenholm Bylin Nellie Bågenholm Bylin Hakon Blomstrand Hakon Blomstrand Mats Fredrikson Elisabeth Åvall-Lundqvist Elisabeth Åvall-Lundqvist Nils O. Elander Nils O. Elander Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic Cancer Frontiers in Oncology pancreatic cancer palliative therapy cancer chemotherapy prognostic factors CA-19-9 antigen human plasma albumin |
| title | Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic Cancer |
| title_full | Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic Cancer |
| title_fullStr | Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic Cancer |
| title_full_unstemmed | Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic Cancer |
| title_short | Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic Cancer |
| title_sort | real world evidence on second line palliative chemotherapy in advanced pancreatic cancer |
| topic | pancreatic cancer palliative therapy cancer chemotherapy prognostic factors CA-19-9 antigen human plasma albumin |
| url | https://www.frontiersin.org/article/10.3389/fonc.2020.01176/full |
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