Efficacy of Capecitabine Plus Oxaliplatin Combination Chemotherapy for Advanced Pancreatic Cancer after Failure of First-Line Gemcitabine-Based Therapy

Abstract

Background/AimsSecond-line chemotherapy in patients with advanced pancreatic ductal adenocarcinoma (PDAC) that progresses following gemcitabine-based treatment has not been established. This study aimed to investigate the efficacy and safety of second-line combination chemotherapy with capecitabine and oxaliplatin (XELOX) in these patients.MethodsBetween August 2011 and May 2014, all patients who received at least one cycle of XELOX (capecitabine, 1,000 mg/m2 twice daily for 14 days; oxaliplatin, 130 mg/m2 on day 1 of a 3-week cycle) combination chemotherapy for unresectable or recurrent PDAC were retrospectively recruited. The response was evaluated every 9 weeks, and the tumor response rate, progression-free survival and overall survival, and adverse events were assessed.ResultsSixty-two patients were included; seven patients (11.3%) had a partial tumor response, and 20 patients (32.3%) had stable disease. The median progression-free and overall survival were 88 days (range, 35.1 to 140.9 days) and 158 days (range, 118.1 to 197.9 days), respectively. Patients who remained stable longer with frontline therapy (≥120 days) exhibited significantly longer progression-free and overall survival. The most common grade 3 to 4 adverse events in patients were vomiting (8.1%) and anorexia (6.5%). There was one treatment-related mortality caused by severe neutropenia and typhlitis.ConclusionsSecond-line XELOX combination chemotherapy demonstrated an acceptable response and survival rate in patients with advanced PDAC who had failed gemcitabine-based chemotherapy.

DBDx-based drug combinations show highly potent therapeutic efficacy against human pancreatic cancer xenografts in athymic mice

“…4,9 Capecitabine is used in combination with gemicitabine or other chemotherapeutics to enhance dwthe therapeutic efficacy in pancreatic cancer. [10][11][12] Our present research proves that DBDx effectively inhibits the growth of pancreatic cancer xenografts. When combined with gemcitabine or capecitabine, its antitumor activity is further improved.…”

Efficacy and tolerability of the combination of nano-liposomal irinotecan and 5-fluorouracil/leucovorin in advanced pancreatic adenocarcinoma: post-approval clinic experience

“…Role of FOLFIRINOX postgemcitabine failure has been examined in a small phase 2 study by Kobayashi et al with a promising median OS of 9.8 months although a high rate of neutropenia (66.7%) was noted (26). Xelox i.e., capecitabine and oxaliplatin for gemcitabine resistant disease was examined in two phase 2 studies resulting in similar outcomes with a median OS of 5.7 and 5.3, respectively (27,28). The survival statistics reported by the aforementioned trials evaluating various regimens seem similar to nal-IRI + 5-FU/LV on face value, however, evidence is limited and stems from underpowered phase 2 or retrospective studies and no head to head comparisons exist.…”

Analysis of Clinical Predictive Factors Affecting the Outcome of Second-Line Chemotherapy for Gemcitabine-Refractory Advanced Pancreatic Cancer

“…12 Current guideline for advanced pancreatic cancer recommends SL after the FL failure, even though the benefit of SL remains to be controversial. 13 The CONKO-003 study, an open randomized phase 3 study, proved that the combination of oxaliplatin, 5-FU, and folinic acid (OFF regimen) after previous gemcitabine-based chemotherapy was superior to BSC in terms of PFS (13 weeks vs 9 weeks) and OS (26 weeks vs 13 weeks). 7 However, there is no more concrete evidence to support the usefulness of SL for gemcitabine-refractory advanced pancreatic cancer.…”