Second line with oxaliplatin- or irinotecan-based chemotherapy for gemcitabine-pretreated pancreatic cancer: A systematic review

• Published in: European journal of cancer (1990) 2017-08, Vol.81, p.174-182
• Main Authors: Petrelli, Fausto, Inno, Alessandro, Ghidini, Antonio, Rimassa, Lorenza, Tomasello, Gianluca, Labianca, Roberto, Barni, Sandro
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Cancer; Chemotherapy; Clinical trials; Clinical Trials as Topic; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Disease control; Gemcitabine; Hematology, Oncology and Palliative Medicine; Humans; Irinotecan; Metastases; Metastasis; Organoplatinum Compounds - administration & dosage; Oxaliplatin; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - secondary; Patients; Prospective Studies; Response rates; Review; Salvage; Salvage Therapy - methods; Second line; Statistical tests; Studies; Survival
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2017.05.025

Abstract Background oxaliplatin (OXA)- and irinotecan (IRI)-based chemotherapies are the most frequently used salvage regimens in patients with metastatic pancreatic cancer (PC) after first-line gemcitabine-based therapy. There are no prospective comparisons of these regimens in this setting. We conducted a systematic review of published trials to compare the efficacy of these treatments. Methods studies that enrolled patients with stage IV disease receiving chemotherapy with OXA or IRI plus fluoropyrimidines were identified using electronic databases (Pubmed, Embase, SCOPUS, CINAHL, Web of Science and Cochrane Library). Clinical outcomes were compared using weighted values of median overall survival (OS), progression-free survival (PFS), response rates (RRs), and clinical benefit rates (CBRs). A 2-tailed t -test with a significance level of 0.05 for comparisons of continuous variables and a Chi-squared test for comparisons of proportions were used. Results overall, 24 studies were included. The pooled overall response rate (ORR), disease control rate (DCR), PFS and OS were 11%, 37.9%, 2.87 and 5.48 months respectively. There was no significant difference in response rates between OXA-based and IRI-based chemotherapies (11.9% versus 8.7%; Chi-squared P = 0.1), respectively. Also there was no significant difference in median PFS (2.9 months versus 2.7 months; t -test P = 0.72), OS (5.3 months versus 5.5 months; t -test P = 0.72), but a greater DCR with OXA-based chemotherapy (41.1% versus 29.4%; Chi-squared P = 0.0008). Conclusion OXA- and IRI-containing regimens were associated with similar efficacy when used after gemcitabine-based chemotherapy in patients with advanced pancreatic cancer.