A Prognostic Model to Identify Patients with Advanced Pancreas Adenocarcinoma Who Could Benefit from Second-line Chemotherapy

Abstract

Aims: The role of salvage chemotherapy after first-line therapy in advanced pancreatic cancer has not yet been established. We intended to identify prognostic factors for long-term survival of advanced pancreatic adenocarcinoma patients with second-line chemotherapy and to devise a prognostic model of clinical parameters. Patients and methods: We analysed 90 patients who had received second-line chemotherapy after the failure of first-line therapy in recurrent or metastatic pancreatic adenocarcinoma between August 2003 and December 2008. Results: The median age at the time of second-line chemotherapy was 61.9 years (range 39.8-74.9) and the median Eastern Cooperative Oncology Group (ECOG) performance status was 1 (0-2). Median progression-free survival and overall survival for second-line chemotherapy were 2.1 and 4.5 months, respectively, with an overall response rate of 10%. In multivariate analysis, an ECOG performance status of 2 or more, non-responder for first-line chemotherapy and albumin level of <3.5 mg/dl were independent prognostic factors for decreased overall survival for all 90 patients. Overall survival was estimated based on the number of adverse prognostic factors: zero or one (good prognostic group), two (intermediate group) or three (poor prognostic group). The median overall survival for good (n = 50), intermediate (n = 24) and poor (n = 16) prognostic groups was 5.5, 3.3 and 2.1 months, respectively (P <0.001). Conclusion: Our result suggests that second-line chemotherapy may be beneficial for overall survival in patients with ECOG performance status 0-1, albumin level >= 3.5 mg/dl and response to first-line chemotherapy. (C) 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.