Third-line S-1 or FOLFOX treatment in advanced pancreatic cancer who received gemcitabine+nab-paclitaxel and nanoliposomal-irinotecan+5-fluorouracil/leucovorin

BACKGROUND: To examine the efficacies of S-1 and FOLFOX as third-line treatment for patients with advanced pancreatic cancer. METHODS: We retrospectively analyzed the electronic medical record data of patients who received nanoliposomal-irinotecan+5-fluorouracil/leucovorin (nal-IRI+5FU/LV) as second-line treatment after first-line gemcitabine+nab-paclitaxel (GEM+nab-PTX) at the National Cancer Center Hospital (Tokyo, Japan) between June 2020 and May 2023. RESULTS: In total, 100 patients were included, 41 of whom received S-1 (n=19) or FOLFOX (n=22) as third-line therapy. The median age of patients who received S-1 and FOLFOX was 74 (range: 56–85) and 76 (46–81) years. The number of females, those with performance status (PS) 0, those with PS 1, and those with adenocarcinoma histology who received S-1/FOLFOX were 8/14, 6/11, 13/11, and 18/20. Median progression-free survival (PFS), median overall survival (OS), objective response rate, and disease control rate for S-1/FOLFOX were 2.8/2.2 months, 4.4/5.1 months, 0/0%, and 36.8/27.3%, the most common grade ≥3 adverse events were anemia (4/1) and elevated alanine transaminase levels (1/3). Adverse events were consistent with the known limits, and there were no treatment-related deaths. CONCLUSIONS: In patients with advanced pancreatic cancer treated with GEM+nab-PTX, followed by nal-IRI+5FU/LV, third-line treatment with S-1 or FOLFOX was tolerable. However, further therapeutic development is warranted because these regimens have only modest activities.