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Second-line palliative chemotherapy, survival, and prognostic factors in patients with advanced pancreatic cancer

Ekström, Anders LU ; Brun, Eva LU ; Eberhard, Jakob LU and Segerlantz, Mikael LU (2021) In Acta Oncologica 60(12). p.1580-1588
Abstract
Introduction: Pancreatic cancer is a highly lethal disease with a close association between incidence and mortality. First-line (FL) palliative chemotherapy prolongs survival and alleviates cancer-related symptoms. However, the survival benefit of second-line (SL) treatment is uncertain, as studies fail to consistently show prolonged survival for any given SL treatment, and in the absence of prognostic factors patients will receive a futile treatment. The aim of this study was to examine prognostic factors and survival in patients with pancreatic cancer, with special reference to SL therapy. Material and methods: This retrospective study included all patients with histopathologically verified pancreatic adenocarcinoma who received... (More)
Introduction: Pancreatic cancer is a highly lethal disease with a close association between incidence and mortality. First-line (FL) palliative chemotherapy prolongs survival and alleviates cancer-related symptoms. However, the survival benefit of second-line (SL) treatment is uncertain, as studies fail to consistently show prolonged survival for any given SL treatment, and in the absence of prognostic factors patients will receive a futile treatment. The aim of this study was to examine prognostic factors and survival in patients with pancreatic cancer, with special reference to SL therapy. Material and methods: This retrospective study included all patients with histopathologically verified pancreatic adenocarcinoma who received palliative chemotherapy at Skåne University Hospital and died between 1 Feb 2015 and 31 Dec 2017. Results: During the study period, a total of 170 patients with pancreatic cancer died after receiving palliative chemotherapy. Of these, 72 had received SL treatment after progression on FL treatment. Median overall survival (OS) from the start of SL treatment was 5.0 months (95% CI: 4.0–6.1). Median OS was 2.9 months for patients with performance status 2 at start of SL treatment compared to 5.3 months for patients with performance status 0–1 (p =.03), and 3.5 months (95% CI: 3.0–5.4) in patients with hypoalbuminemia (<36 g/L) at the start of SL therapy compared to 8.0 months (95% CI: 5.3–11.1) for patients with normal albumin levels (p =.009). Weight loss during FL therapy, a doubling of CA 19-9 after FL therapy, and length of progression-free survival during FL treatment were not associated with survival following SL therapy. Conclusion: Poor performance status and hypoalbuminemia are negative prognostic factors for survival on SL palliative treatment in patients with advanced pancreatic cancer. Possible gain in survival should be carefully considered before initiating SL chemotherapy. (Less)
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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Oncologica
volume
60
issue
12
pages
1580 - 1588
publisher
Taylor & Francis
external identifiers
  • scopus:85114464282
  • pmid:34486921
ISSN
1651-226X
DOI
10.1080/0284186X.2021.1973680
project
Gastrointestinal cancer - quality of life and survival after palliative chemotherapy
language
English
LU publication?
yes
id
3a25abea-0807-4a48-b092-d5954687c14a
date added to LUP
2021-10-05 16:25:25
date last changed
2024-05-18 15:55:51
@article{3a25abea-0807-4a48-b092-d5954687c14a,
  abstract     = {{Introduction: Pancreatic cancer is a highly lethal disease with a close association between incidence and mortality. First-line (FL) palliative chemotherapy prolongs survival and alleviates cancer-related symptoms. However, the survival benefit of second-line (SL) treatment is uncertain, as studies fail to consistently show prolonged survival for any given SL treatment, and in the absence of prognostic factors patients will receive a futile treatment. The aim of this study was to examine prognostic factors and survival in patients with pancreatic cancer, with special reference to SL therapy. Material and methods: This retrospective study included all patients with histopathologically verified pancreatic adenocarcinoma who received palliative chemotherapy at Skåne University Hospital and died between 1 Feb 2015 and 31 Dec 2017. Results: During the study period, a total of 170 patients with pancreatic cancer died after receiving palliative chemotherapy. Of these, 72 had received SL treatment after progression on FL treatment. Median overall survival (OS) from the start of SL treatment was 5.0 months (95% CI: 4.0–6.1). Median OS was 2.9 months for patients with performance status 2 at start of SL treatment compared to 5.3 months for patients with performance status 0–1 (p =.03), and 3.5 months (95% CI: 3.0–5.4) in patients with hypoalbuminemia (&lt;36 g/L) at the start of SL therapy compared to 8.0 months (95% CI: 5.3–11.1) for patients with normal albumin levels (p =.009). Weight loss during FL therapy, a doubling of CA 19-9 after FL therapy, and length of progression-free survival during FL treatment were not associated with survival following SL therapy. Conclusion: Poor performance status and hypoalbuminemia are negative prognostic factors for survival on SL palliative treatment in patients with advanced pancreatic cancer. Possible gain in survival should be carefully considered before initiating SL chemotherapy.}},
  author       = {{Ekström, Anders and Brun, Eva and Eberhard, Jakob and Segerlantz, Mikael}},
  issn         = {{1651-226X}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{1580--1588}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Oncologica}},
  title        = {{Second-line palliative chemotherapy, survival, and prognostic factors in patients with advanced pancreatic cancer}},
  url          = {{http://dx.doi.org/10.1080/0284186X.2021.1973680}},
  doi          = {{10.1080/0284186X.2021.1973680}},
  volume       = {{60}},
  year         = {{2021}},
}