Efficacy of third-line chemotherapy following nanoliposomal irinotecan combined with fluorouracil and folinic acid as second-line treatment for unresectable pancreatic cancer

Efficacy of third-line chemotherapy following nanoliposomal irinotecan combined with fluorouracil and folinic acid as second-line treatment for unresectable pancreatic cancer

IntroductionThe significance of third-line chemotherapy (CTx) in unresectable pancreatic cancer (UPC) remains unclear. This study evaluated the therapeutic impact of third-line CTx after nanoliposomal irinotecan and fluorouracil combined with folinic acid (nal-IRI + 5-FU/LV) therapy as second-line C...

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Main Authors: Keisuke Miwa, Reina Kawasaki, Mototsugu Shimokawa, Taiga Otsuka, Toshimitsu Tanaka, Masaru Fukahori, Taro Shibuki, Junichi Nakazawa, Shiho Arima, Futa Koga, Yujiro Ueda, Yoshihito Kubotsu, Hozumi Shimokawa, Shigeyuki Takeshita, Kazuo Nishikawa, Azusa Komori, Satoshi Otsu, Ayumu Hosokawa, Tatsunori Sakai, Hisanobu Oda, Machiko Kawahira, Shuji Arita, Takuya Honda, Hiroki Taguchi, Kengo Tsuneyoshi, Toshihiro Fujita, Takahiro Sakae, Yasunori Kawaguchi, Tsuyoshi Shirakawa, Toshihiko Mizuta, Kenji Mitsugi
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Oncology
Subjects:
pancreatic cancer
chemotherapy
third-line treatment
nanoliposomal irinotecan
best supportive care
Online Access:https://www.frontiersin.org/articles/10.3389/fonc.2025.1626689/full
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Summary:IntroductionThe significance of third-line chemotherapy (CTx) in unresectable pancreatic cancer (UPC) remains unclear. This study evaluated the therapeutic impact of third-line CTx after nanoliposomal irinotecan and fluorouracil combined with folinic acid (nal-IRI + 5-FU/LV) therapy as second-line CTx for UPC.MethodsBetween June 2020 and May 2021, 104 patients who received nal-IRI + 5-FU/LV therapy as second-line CTx were retrospectively analyzed for post-discontinuation survival (PDS) and overall survival (OS). Comparisons were made between patients transitioning to third-line CTx and those receiving best supportive care (BSC), using a Cox proportional hazards model adjusted for patient background.ResultsOf the cohort, 34 patients received third-line CTx, whereas 61 transitioned to BSC. The median OS from first-line CTx in the third-line CTx group was 18.0 months, with a median OS of 9.7 months from second-line CTx. Adjusted median PDS following second-line CTx was 6.5 months for the third-line CTx group compared to 2.3 months for the BSC group (adjusted hazard ratio 0.16; 95% confidence interval 0.08–0.32; P < 0.01).ConclusionThird-line CTx should be actively considered for patients with UPC, as the approach may significantly extend survival in those who can tolerate the treatment.
ISSN:2234-943X

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