Impact of second-line combination chemotherapy on post-progression survival in metastatic and recurrent pancreatic cancer

BackgroundThis study aimed to evaluate the efficacy of the second-line combination chemotherapy (CC) for patients with metastatic or recurrent pancreatic cancer. MethodsWe retrospectively analyzed consecutive patients with metastatic or recurrent pancreatic cancer, who received second-line chemotherapy after disease progression on first-line modified FOLFIRINOX (mFFX) or gemcitabine with nab-paclitaxel (GnP) between January 2014 and March 2023 at our hospital. Overall survival (OS), progression-free survival (PFS), and post-progression survival (PPS) were compared between first-line mFFX and GnP. In addition, OS, PFS, and PPS for second-line treatment with CC and single-agent chemotherapy (SAC) were compared using propensity score matching (PSM). Results457 patients (mFFX/GnP: 122/335) were included. Median OS and PPS of mFFX and GnP were 15.5 months vs. 15.0 months (p = 0.73) and 7.7 months vs. 7.2 months (p = 0.37), respectively. After PSM, median OS and median PPS were significantly longer in the CC group than in the SAC group (OS: 16.3 months vs. 12.8 months, p < 0.01; PPS: 8.0 months vs. 5.5 months, p < 0.01). There was no difference in first-line PFS between the two groups (7.1 months vs. 6.4 months, p = 0.74). Performance status at the beginning of first-line treatment, and carbohydrate antigen 19-9 level, Glasgow prognostic score at the end of first-line treatment, and second-line CC were independently associated with OS. ConclusionSecond-line CC achieved longer PPS and OS than SAC. To improve OS, it was important to receive second-line CC.