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Can response to treatment predict outcome in patients with metastatic pancreatic adenocarcinoma (MPAC)?
Background: Front-line (FL) chemotherapy regimens for MPAC include FOLFIRINOX (FFX)/FOLFOX (FX) and Nab-paclitaxel plus Gemcitabine (NabG). We examined our hypothesis that objective response (OR) to these regimens can influence clinical outcome when employed sequentially. Methods: All MPAC patients treated with FFX/FX or NabG from 1/1/2011 to 12/31/2014 at the Froedtert and Medical College of Wisconsin (MCW) Clinical Cancer Center were reviewed. This study was approved by the MCW Institutional Review Board. Results: 64 patients were evaluated and the baseline characteristics are summarized in the table below. OR to FL chemotherapy included partial response(PR) - 23/64 (35.9%), stable disease (SD) - 14/64 (21.9%) and disease control rate (DCR) of 57.8%; OR to second line (SL) therapy included PR - 7/37 (18.9%), SD - 14/37 (37.8%) and DCR of 56.7%. Only 57.8% patients received SL chemotherapy. Among patients who demonstrated PR to FL chemotherapy, 64% were refractory to SL chemotherapy, while 33% of patients who were refractory to FL chemotherapy demonstrated a PR to SL chemotherapy. 3/64 patients who demonstrated PR to both FL and SL chemotherapy had excellent outcomes with overall survival (OS) of 20.9 months, 37 months and not met (PFS of 11 months to FL chemo and ongoing response of > 4 months to SL chemo). Median OS of patients who demonstrated a PR/SD to FL and SL chemotherapy (15/64; 23.4 %) was 20.9 months. The patients who demonstrated progressive disease(PD) to both FL and SL chemotherapy (5/64; 7.8%) had a median OS of 3.8 months. Conclusions: Patients with MPAC who are refractory to FL chemotherapy may demonstrate a response to SL chemotherapy. Patients who are able to undergo sequential therapy with FFX/FX and NabG (in either sequence) and demonstrate either a PR or SD with both treatment regimens have an excellent clinical outcome. The minority of patients who demonstrate PR to both sequential regimens have a distinctly different outcome compared to patients who demonstrate PD to both regimens; tumors from these two subsets of patients need to be better characterized to improve our understanding of pancreatic cancer biology.
|Median at diagnosis||No=64|
Abstracts by Shinoj Pattali Jayavalsan:
Can the sequence of chemotherapy regimens influence outcome in patients with metastatic pancreatic adenocarcinoma (MPAC)?Meeting: 2016 Gastrointestinal Cancers Symposium | Abstract No: 428
Outcomes in metastatic pancreatic adenocarcinoma (MPAC) patients treated with FOLFIRINOX (FFX)/FOLFOX(FX) and gemcitabine + nab-paclitaxel (NabG).Meeting: 2016 Gastrointestinal Cancers Symposium | Abstract No: 397