Table_1_Third-line treatment options in metastatic pancreatic cancer patients: a real-world study.xlsx

BackgroundThere are currently no standard therapy regimens for the third-line treatment of metastatic pancreatic cancer (mPC) patients. The aim of the present study was to compare the efficacy and safety of different third-line therapy regimens for mPC in the real-world.
MethodsThis study retrospectively analyzed mPC patients admitted to Zhejiang Provincial People’s Hospital between June 2013 and January 2023. All patients’ diagnoses were pathologically confirmed and their treatment was continued after the second-line therapy failed. The primary study endpoints included median overall survival (mOS), median progression-free survival (mPFS), and disease control rate (DCR).
ResultsA total of 72 patients were enrolled in the study. Of these, 36 patients received chemotherapy alone, 16 received chemotherapy combined with targeted therapy or immunotherapy, 14 received chemotherapy-free antitumor therapy, and six received palliative care. The mPFS value for these groups was 4.40 months, 5.20 months, 2.33 months, and 0.80 months, respectively. The mOS value was 6.90 months, 5.90 months, 3.33 months, and 0.80 months, respectively. The DCR was 33.4%, 31.3%, 21.4%, and 0.0%, respectively. Overall, there were significant differences in prognosis between the palliative care group and the other treatment groups (mOS, P < 0.001; mPFS P < 0.001; DCR, P < 0.001). The differences among the mPFS, mOS, and DCR for different antitumor therapy regimens were not statistically significant. Compared to the chemotherapy alone group, the chemotherapy combined with targeted therapy or immunotherapy group experienced more adverse events (100% vs. 75.0%; P = 0.002). Chemotherapy combined with targeted therapy or immunotherapy was associated with a higher risk of grade 3/4 hyperaminotransferemia compared to chemotherapy alone (31.3% vs. 0.0%; P = 0.020) and chemotherapy-free antitumor therapy (31.3% vs. 0.0%; P = 0.020).
ConclusionsThird-line antitumor therapy can prolong the survival time of patients with mPC. Targeted therapy or immunotherapy failed to further improve survival benefits based on chemotherapy results. Patients who underwent the third-line treatment with good physical status and family history of cancer were independent prognostic factors for longer mOS. The sequencing of fluorouracil and gemcitabine in the front-line therapy did not affect third-line mOS.

背景：目前针对转移性胰腺癌（metastatic pancreatic cancer, mPC）患者的三线治疗暂无标准治疗方案。本研究旨在真实世界环境中对比不同三线治疗方案用于mPC的疗效与安全性。
方法：本研究回顾性分析了2013年6月至2023年1月期间收治于浙江省人民医院的mPC患者。所有患者均经病理学确诊，且在二线治疗失败后继续接受治疗。本研究的主要终点包括中位总生存期（median overall survival, mOS）、中位无进展生存期（median progression-free survival, mPFS）以及疾病控制率（disease control rate, DCR）。
结果：本研究共纳入72例患者。其中36例仅接受化疗，16例接受化疗联合靶向治疗或免疫治疗，14例接受无化疗抗肿瘤治疗，6例接受姑息治疗。四组患者的mPFS分别为4.40个月、5.20个月、2.33个月及0.80个月；mOS分别为6.90个月、5.90个月、3.33个月及0.80个月；DCR分别为33.4%、31.3%、21.4%及0.0%。整体而言，姑息治疗组与其余治疗组的预后存在显著差异（mOS：P<0.001；mPFS：P<0.001；DCR：P<0.001）。不同抗肿瘤治疗方案间的mPFS、mOS及DCR差异无统计学意义。与仅化疗组相比，化疗联合靶向治疗或免疫治疗组的不良事件发生率更高（100% vs. 75.0%；P=0.002）。相较于仅化疗组与无化疗抗肿瘤治疗组，化疗联合靶向治疗或免疫治疗组的3/4级氨基转移酶升高风险更高（分别为31.3% vs. 0.0%，P=0.020；31.3% vs. 0.0%，P=0.020）。
结论：三线抗肿瘤治疗可延长mPC患者的生存时间。在化疗基础上联用靶向治疗或免疫治疗并未进一步改善生存获益。身体状况良好且有癌症家族史的三线治疗患者，是获得更长mOS的独立预后因素。一线治疗中氟尿嘧啶与吉西他滨的用药顺序，并不会对三线治疗的mOS产生影响。