SNFGE SNFGE
 
Thématique :
- Cancers autres (hors CCR et CHC)
Originalité :
Très original
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Sylvain MANFREDI
Coup de coeur :
 
 
Digestive and Liver Disease
  2017/06  
 
  2017 Jun;49(6):692-696. doi  
  doi: 10.1016/j.dld.2017.02.007.  
 
  Gemcitabine as second-line chemotherapy after Folfirinox failure in advanced pancreatic adenocarcinoma: A retrospective study  
 
  Viaud J, Brac C, Artru P, Le Pabic E, Leconte B, Bodère A, Pracht M, Le Sourd S, Edeline J, Lièvre A  
  https://www.ncbi.nlm.nih.gov/pubmed/28256401  
 
 

Abstract

BACKGROUND:

Pancreatic adenocarcinoma (PA) is diagnosed in most cases at an advanced stage requiring chemotherapy. Folfirinox is the standard first-line treatment. After Folfirinox failure, gemcitabine alone is routinely used as second-line therapy without data supporting this attitude.

AIM:

Determine the response rate and outcome of patients with advanced PA treated with gemcitabine after Folfirinox failure.

METHODS:

We retrospectively analyzed all consecutive patients treated with gemcitabine after Folfirinox failure for a locally advanced or metastatic PA between 2009 and 2015. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Response rate, control rate and tolerability were assessed.

RESULTS:

96 patients were included (male, 51%; median age, 62; performance status (PS) 0-1, 47%). Median duration on gemcitabine was 2.1 months. The overall disease control rate was 40%. Median OS was 3.7 months (95%CI: 2.5-5.2) and median PFS was 2.1 months (95%CI: 2.0-2.6). Reasons for treatment discontinuation were mostly progression (51%). Age at diagnosis and PS were independently associated with OS in multivariate analysis (HR of 1.86; p=0.0055 and 2.42; p<0.0001 respectively). 34 patients experienced a grade 3 adverse event.

CONCLUSIONS:

This study suggests that gemcitabine is not beneficial to all patients failing on Folfirinox first-line therapy and should be restricted to young patients with good PS.

 

 
Question posée
 
Le gemzar en 2ème ligne après échec du FOLFIRINOX est-il efficace?
 
Question posée
 
Peu efficace, à réserver aux sujets jeunes en bon état général.
 
Commentaires

Pas une étude randomisée, mais étude de cohorte de la vraie vie. 

 
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