Second- and third-line chemotherapy in patients with metastatic pancreatic adenocarcinoma: Feasibility and potential benefits in a retrospective series of 117 patients

Background. -Chemotherapy is effective in metastatic pancreatic adenocarcinoma (PAC), but the benefits of second- and third-tine chemotherapy remain unclear. Methods. - We studied all patients followed consecutively for metastatic PAC, and registered at our institution between 1997 and 2006. We retrospectively analyzed the following data in terms of chemotherapy: tumor response; time to tumor progression (TTP) for each line; and overall survival (OS). Efficacy of second-line regimens was assessed using the growth modulation index (GMI). Results. - Out of 117 patients, 99 (85%) received at least one tine of chemotherapy, 53 (45%) received two tines and 24 (21%) had three or more lines. Median OS was 6.7months for all 117 patients, 1.8 months for 18 patients who never received chemotherapy, 4.6 months for 46 patients who received one-line chemotherapy and 11.5 months for 53 patients who received at least two Lines. Median OS from the beginning of the second-line was 4.7 months. The GMI demonstrated beneficial effects of second-line treatment on disease progression, with a GMI greater than 1.33 in 57% (30/53) of patients. Conclusion. - More than half the patients with metastatic PAC progression white receiving one-line chemotherapy achieved better disease control on receiving two tines of treatment. (C) 2009 Elsevier Masson SAS. All rights reserved.