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Maintenance chemotherapy in advanced and metastatic pancreatic cancer, a case series
Background
Pancreatic cancer is the 12th most common cancer in the world and is responsible for 7% of all cancer deaths. Limited data exists on the management of patients with locally advanced or metastatic pancreatic cancer who achieve stable disease/response after first-line chemotherapy. In this setting, maintenance therapy is important to minimize toxicity while preserving survival benefit. Olaparib is the only drug approved for maintenance therapy in patients with metastatic pancreatic cancer and germline Breast Cancer (BRCA) gene mutation, and data from the phase II PANOPTIMOX-PRODIGE35 trial showed clinical benefit from the use of 5-fluorouracil (5-FU) as maintenance. Our aim is to evaluate the progression-free survival (PFS) of genetically unselected patients with locally advanced or metastatic pancreatic cancer, who received maintenance therapy following good response to induction chemotherapy with FOLFIRINOX (Leucovorin Calcium, Fluorouracil, Irinotecan Hydrochloride, Oxaliplatin).
Methods
We conducted a retrospective review of patients diagnosed with locally advanced or metastatic pancreatic adenocarcinoma who have received induction chemotherapy followed by maintenance therapy, between January 2014 and October 2021, at the American University of Beirut Medical Center, Lebanon. We excluded patients who had disease progression on FOLFIRINOX.
Results
12 patients met the inclusion criteria; median age at diagnosis was 62 years (min 50 – max 75), 83% were males, 10 had metastasis and 2 had locally advanced disease. All patients received FOLFIRINOX as induction chemotherapy, with a median duration of 5.13 months, and 2 patients had to discontinue Oxaliplatin due to neurotoxicity. 7 patients received 5-FU as maintenance therapy, 4 received FOLFIRI (Leucovorin Calcium, Fluorouracil, Irinotecan Hydrochloride) and 1 patient received FOLFIRI as de-escalation from FOLFIRINOX followed by 5-FU. Median duration of maintenance therapy irrespective of the regimen used was 15.2 months. 6 patients had disease progression on maintenance therapy (including two deaths). The overall median PFS was 22.13 months (95% CI; 10.99- 33.26) and maximal PFS reached for 1 patient, on FOLFIRI/5FU de-escalation/maintenance, was 42.1 months. 3 of the patients who progressed on maintenance were restarted on FOLFIRINOX, 1 received Gemcitabine and Nab-Paclitaxel, 1 received radiotherapy for local recurrence followed by palliative surgery and Pembrolizumab, and 1 patient received radiotherapy for local recurrence then continued maintenance therapy with 5-FU. Our results show a higher PFS compared to other studies in the literature, in which median PFS ranges between 5 and 10.6 months, however we cannot draw further conclusions as we are limited by our small sample size.
Conclusions
Emerging studies are supporting the use of maintenance therapy in metastatic and advanced pancreatic cancer. Although our study is limited by its small sample size, the results are promising and encourage further exploration of this topic in larger prospective trials.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
