Impact of previous S-1 treatment on efficacy of liposomal irinotecan plus 5-fluorouracil and leucovorin in patients with metastatic pancreatic cancer

Cheng-Yu Tang; Shih-Hung Yang; Chung-Pin Li; Yung-Yeh Su; Sz-Chi Chiu; Li-Yuan Bai; Yan-Shen Shan; Li-Tzong Chen; Shih-Chang Chuang; De-Chuan Chan; Chia-Jui Yen; Cheng-Ming Peng; Tai-Jan Chiu; Yen-Yang Chen; Jen-Shi Chen; Nai-Jung Chiang; Wen-Chi Chou

doi:10.1016/j.pan.2024.03.014

Impact of previous S-1 treatment on efficacy of liposomal irinotecan plus 5-fluorouracil and leucovorin in patients with metastatic pancreatic cancer

Pancreatology. 2024 Mar 25:S1424-3903(24)00076-0. doi: 10.1016/j.pan.2024.03.014. Online ahead of print.

Authors

Cheng-Yu Tang¹, Shih-Hung Yang², Chung-Pin Li³, Yung-Yeh Su⁴, Sz-Chi Chiu⁵, Li-Yuan Bai⁶, Yan-Shen Shan⁷, Li-Tzong Chen⁸, Shih-Chang Chuang⁹, De-Chuan Chan¹⁰, Chia-Jui Yen¹¹, Cheng-Ming Peng¹², Tai-Jan Chiu¹³, Yen-Yang Chen¹³, Jen-Shi Chen¹⁴, Nai-Jung Chiang¹⁵, Wen-Chi Chou¹⁶

Affiliations

¹ Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Department of Oncology, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
³ School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Department of Oncology, National Cheng Kung University Hospital, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.
⁵ PharmaEngine, Inc., Taipei, Taiwan.
⁶ Division of Hematology-Oncology, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan.
⁷ Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁸ National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan.
⁹ Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁰ Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹¹ Department of Oncology, National Cheng Kung University Hospital, Taipei, Taiwan.
¹² Department of Surgery, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan.
¹³ Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan.
¹⁴ Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
¹⁵ Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: njchiang@vghtpe.gov.tw.
¹⁶ Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: wenchi3992@yahoo.com.tw.

PMID: 38565467
DOI: 10.1016/j.pan.2024.03.014

Abstract

Background/objectives: Liposomal irinotecan plus 5-fluorouracil and leucovorin (nal-IRI + 5-FU/LV) provides survival benefits for metastatic pancreatic adenocarcinoma (mPDAC) refractory to gemcitabine-based treatment, mainly gemcitabine plus nab-paclitaxel (GA), in current practice. Gemcitabine plus S-1 (GS) is another commonly administered first-line regimen before nab-paclitaxel reimbursement; however, the efficacy and safety of nal-IRI + 5-FU/LV for mPDAC after failed GS treatment has not been reported and was therefore explored in this study.

Methods: In total, 177 patients with mPDAC received first-line GS or GA treatment, followed by second-line nal-IRI + 5-FU/LV treatment (identified from a multicenter retrospective cohort in Taiwan from 2018 to 2020); 85 and 92 patients were allocated to the GS and GA groups, respectively. Overall survival (OS), time-to-treatment failure (TTF), and adverse events were compared between the two groups.

Results: The baseline characteristics of the two groups were generally similar; however, a higher median age (67 versus 62 years, p < 0.001) and fewer liver metastases (52% versus 78%, p < 0.001) were observed in the GS versus GA group. The median OS was 15.0 and 15.9 months in the GS and GA groups, respectively (p = 0.58). The TTF (3.1 versus 2.8 months, p = 0.36) and OS (7.6 versus 6.7 months, p = 0.83) after nal-IRI treatment were similar between the two groups. More patients in the GS group developed mucositis during nal-IRI treatment (15% versus 4%, p = 0.02).

Conclusions: The efficacy of second-line nal-IRI +5-FU/LV treatment was unaffected by prior S-1 exposure. GS followed by nal-IRI treatment is an alternative treatment sequence for patients with mPDAC.

Keywords: Gemcitabine; Nab-paclitaxel; Pancreatic adenocarcinoma.