Paclitaxel as weekly second-line therapy in patients with advanced pancreatic carcinoma

Abstract

Although the prognosis for patients with pancreatic adenocarcinoma is still poor, gemcitabine has shown significant impact upon survival and quality of life. Our aim was to examine the potential effectiveness of a second- or third-line therapy with paclitaxel (Taxol) after confirmed progression with a gemcitabine-containing schedule for patients remaining in good clinical condition. Eighteen patients with stage IVb disease participated in this study. Pretreatment with gemcitabine was performed either as monotherapy and/or in combination with 5-fluorouracil (5-FU) and folic acid (FA). Paclitaxel was administered at weekly intervals on an outpatient basis. We observed 238 weekly treatments with a median number per patient of 12 treatments. The median dosage was 73 mg/m2 paclitaxel (range 55-88 mg/m2). Regarding toxicity, only one patient each presented with anemia and leukocytopenia of WHO grade III. Hepatotoxicity with a temporary increase in aminotransferase of WHO grade II occurred in three patients. Higher-grade symptomatic toxicity was rare, except alopecia. At this time, the median survival time is 17.5 weeks (range 7-88 weeks) since the start of therapy. Stable disease was observed in five patients. One patient achieved complete remission within 37 weeks. At this time, he has survived for more than 56 weeks after confirmed progression under first-line therapy. In conclusion, this schedule demonstrates that weekly therapy with paclitaxel after pretreatment can be effective with a low toxicity profile. This opens up an additional therapeutic option for a selected patient group with a poor prognosis so far.

Phase II study of palliative S-1 in combination with cisplatin as second-line chemotherapy for gemcitabine-refractory pancreatic cancer patients

“…The results of previous studies concerning oxaliplatin (15), ralitrexed (16), paclitaxel (17) and pemetrexed (18) monotherapies in the second-line treatment of pancreatic cancer have revealed modest antitumor effects with no survival benefit. Studies have also reported combination chemotherapeutic regimens as second-line therapies for advanced pancreatic cancer.…”

Raltitrexed–eloxatin salvage chemotherapy in gemcitabine-resistant metastatic pancreatic cancer

“…As no further standard therapeutic option exists and scarce information on the impact on outcome of salvage therapy is available, prospective trials attempting to widen the therapeutic armamentarium against this disease are warranted. So far, very few studies have investigated salvage chemotherapy after failure of gemcitabine or gemcitabine-containing chemotherapy (Stehlin et al, 1999;Oettle et al, 2000;Ulrich-Pur et al, 2003;Cantore et al, 2004;Milella et al, 2004; Reni et al, 2004), one of which was retrospective (Kozuch et al, 2001). The populations selected were different in terms of proportion of patients with PS480, which ranged from 0 to 61%, metastatic patients (73 -100%), patients with liver metastases (57 -85%), patients with 41 prior chemotherapy lines (0 -29%), and median PFS after previous treatment (6.0 -7.9 months), which was rarely reported in other series, while in our exploratory analyses it resulted as an independent factor predicting the outcome of salvage therapy (Table 6).…”

Irinotecan plus raltitrexed vs raltitrexed alone in patients with gemcitabine-pretreated advanced pancreatic adenocarcinoma

“…Other chemotherapeutic drugs, such as paclitaxel (Oettle et al, 2000), rubitecan (Stehlin et al, 1999), and irofulven (Weitman et al, 2001), a unique cytotoxic agent that is related to the mushroom-derived illudins, unfortunately, are only marginally effective or do not seem to hold their promise (D Von Hoff, personal communications).…”