Clinical outcomes of chemotherapy in patients with undifferentiated carcinoma of the pancreas: a retrospective multicenter cohort study

Abstract

Background Undifferentiated carcinoma (UC) of the pancreas is a rare subtype of pancreatic cancer. Although UC has been considered a highly aggressive malignancy, no clinical studies have addressed the efficacy of chemotherapy for unresectable UC. Therefore, we conducted multicenter retrospective study to investigate the efficacy of chemotherapy in patients with UC of the pancreas. Methods This multicenter retrospective cohort study was conducted at 17 institutions in Japan between January 2007 and December 2017. A total of 50 patients treated with chemotherapy were analyzed. Results The median overall survival (OS) in UC patients treated with chemotherapy was 4.08 months. The details of first-line chemotherapy were as follows: gemcitabine (n = 24), S-1 (n = 12), gemcitabine plus nab-paclitaxel (n = 6), and other treatment (n = 8). The median progression-free survival (PFS) was 1.61 months in the gemcitabine group, 2.96 months in the S-1 group, and 4.60 months in the gemcitabine plus nab-paclitaxel group. Gemcitabine plus nab-paclitaxel significantly improved PFS compared with gemcitabine (p = 0.014). The objective response rate (ORR) was 4.2% in the gemcitabine group, 0.0% in the S-1 group, and 33.3% in the gemcitabine plus nab-paclitaxel group. Gemcitabine plus nab-paclitaxel also showed a significantly higher ORR compared with both gemcitabine and S-1 (gemcitabine plus nab-paclitaxel vs. gemcitabine: p = 0.033; gemcitabine plus nab-paclitaxel vs. S-1: p = 0.034). A paclitaxel-containing first-line regimen significantly improved OS compared with a non-paclitaxel-containing regimen (6.94 months vs. 3.75 months, respectively; p = 0.041). After adjustment, use of a paclitaxel-containing regimen in any line was still an independent predictor of OS (hazard ratio for OS, 0.221; 95% confidence interval, 0.076–0.647; p = 0.006) in multiple imputation by chained equation. Conclusions The results of the present study indicate that a paclitaxel-containing regimen would offer relatively longer survival, and it is considered a reasonable option for treating patients with unresectable UC.

Sarcomatoid carcinoma of the pancreas — a rare tumor with an uncommon presentation and course: A case report and review of literature

“…Gemcitabine has been reported to be effective in the event of portal vein thrombosis or tumor recurrence, whereas a cisplatin/etoposide/ifosfamide (VIP) regimen was also found to produce notable results[ 6 ]. Imaoka et al [ 29 ] conducted a multicenter retrospective cohort study to investigate the efficacy of chemotherapy in patients with UCP ( n = 50) showing a median overall survival (OS) of 4.08 mo. The most frequently used first-line treatment regimens were gemcitabine, S-1, and gemcitabine plus nab-paclitaxel.…”

“…The most frequently used first-line treatment regimens were gemcitabine, S-1, and gemcitabine plus nab-paclitaxel. Although there was no significant difference in OS among these first-line regimens, gemcitabine plus nab-paclitaxel significantly improved median progression-free survival compared with gemcitabine alone[ 29 ].…”

“…Furthermore, the impact of adjuvant chemotherapy on the survival of SCP has not been well defined. Imaoka et al [ 29 ] report that a paclitaxel-containing regimen would offer relatively longer survival in patients with unresectable UCP.…”

Undifferentiated Pancreatic Carcinoma With Osteoclast-Like Giant Cells: What Do We Know So Far?

“…FOLFIRINOX is currently preferred to gemcitabine since this results in better overall survival (65). Since patients with undifferentiated carcinoma are often in poor condition, paclitaxel-containing regimens can, however, be considered a reasonable choice; this would offer relatively long survival, as has been shown in a recent retrospective multicenter cohort study (66).…”

The epidemiology of rare types of hepatobiliary and pancreatic cancer from national cancer registry

“…Moreover, these incidences easily met any suggested definition of rare cancers. Although there have been many studies about rare tumors, many of them were retrospective observational studies targeted at single rare tumor types on a limited scale [ 13 , 14 ]. These studies could analyze practice treatment, but were inappropriate to obtain epidemiologic information.…”