Nanoliposomal irinotecan with fluorouracil and folinic acid, FOLFIRINOX, and S-1 as second-line treatment for unresectable pancreatic cancer after gemcitabine/nab-paclitaxel

• Published in: Scientific Reports
• Main Authors: Taro Shibuki, Taiga Otsuka, Mototsugu Shimokawa, Junichi Nakazawa, Shiho Arima, Masaru Fukahori, Keisuke Miwa, Yoshinobu Okabe, Futa Koga, Yujiro Ueda, Yoshihito Kubotsu, Akitaka Makiyama, Hozumi Shimokawa, Shigeyuki Takeshita, Kazuo Nishikawa, Azusa Komori, Satoshi Otsu, Ayumu Hosokawa, Tatsunori Sakai, Hisanobu Oda, Machiko Kawahira, Shuji Arita, Takuya Honda, Hiroki Taguchi, Kengo Tsuneyoshi, Yasunori Kawaguchi, Toshihiro Fujita, Takahiro Sakae, Kenta Nio, Yasushi Ide, Norio Ureshino, Tsuyoshi Shirakawa, Toshihiko Mizuta, Kenji Mitsugi
• Format: Article
• Language: English
• Published: Nature Portfolio 2024-07-01
• Subjects: Pancreatic cancer; Second line; Nanoliposomal irinotecan; S-1; FOLFIRINOX
• Online Access: https://doi.org/10.1038/s41598-024-65689-8

Abstract This study aimed to compare second-line treatment outcomes for patients with unresectable pancreatic cancer previously treated with gemcitabine plus nab–paclitaxel (GnP) therapy. We conducted an integrated analysis of two retrospective studies included 318 patients receiving nanoliposomal irinotecan + 5-fluorouracil/folinic acid (NFF) (n = 102), S-1 (n = 57), or FOLFIRINOX (n = 14) as second-line treatment. Median overall survival (OS) in the NFF group was 9.08 months, significantly better than S-1 (4.90 months, P = 0.002). FOLFIRINOX had a median OS of 4.77 months, not statistically different from NFF. Subgroup analyses of OS indicated NFF was generally superior, however, a statistical interaction was observed between the treatment regimen in serum Alb < 3.5 g/dL (P = 0.042) and serum CRP ≥ 0.3 mg/dL (P = 0.006). Median progression-free survival (PFS) was 2.93 months for NFF, significantly better than S-1 (2.53 months, P = 0.024), while FOLFIRINOX had a comparable PFS (3.04 months, P = 0.948). Multivariate analysis identified the serum CRP, serum CA19-9, duration of first-line GnP therapy, and use (yes/no) of S-1 for second-line treatment as independent predictors for OS. This study concludes that second-line NFF therapy demonstrated a more favorable OS compared to S-1 therapy, however, it is still important to consider the patient background characteristics while selecting the most appropriate treatment.