• Kaori Hino, Tomohiro Nishina, Yuuki Numata, Akinori Asagi, Tomonori Inoue, Megumi Yoshimatsu, Chihiro Sakaguchi, Akio Nakasya, Norifumi Nishide, Takeshi Kajiwara, Takashi Terao, Seijin Nadano, Kaori Marui, Yusuke Okujima, Masahito Kokubu, Yoshiki Imamura, Kozue Kanemitsu, Mitsuhito Koizumi, Teru Kumagi, Yoichi Hiasa, and Ichinosuke Hyodo.
• Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Japan.
• Intern. Med. 2022 Jan 1; 61 (15): 225522612255-2261.

AbstractObjective S-1 and modified FOLFIRINOX (mFFX) were often used as the second-line chemotherapies after failure of gemcitabine plus nab-paclitaxel (GnP) in unresectable pancreatic cancer (UPC) until nanoliposomal irinotecan plus 5-fluorouracil/leucovorin therapy was approved as an alternative in Japan in 2020. However, the clinical outcomes of S-1 and mFFX after GnP have scarcely been reported. Therefore, we retrospectively studied them. Methods We extracted the clinical data of 86 patients with UPC who received second-line chemotherapy after GnP between 2015 and 2020. Among the patients who had a good organ functions and no massive ascites, 41 patients treated with S-1 and 21 treated with mFFX were enrolled. Results Compared to S-1, mFFX tended to be used for younger patients with a good general condition (median age, 63 vs. 71 years, p<0.01; and performance status 0, 67% vs. 37%, p<0.05). The median progression-free and overall survival were similar between the S-1 (3.7 and 7.2 months, respectively) and mFFX (3.3 and 7.4 months, respectively) groups. The response rate in patients with measurable lesions was 4% (n=1/23) in the S-1 group and 17% (n=2/12) in the mFFX group. The incidence of grade 3 or 4 adverse events was 20% in the S-1 group and 57% (neutrophil count decreased in 43%) in the mFFX group (p<0.01). Conclusion S-1 and mFFX were both acceptable second-line chemotherapies after GnP therapy for UPC, although attention should be paid to myelosuppression during mFFX treatment. Further studies involving nanoliposomal irinotecan plus 5-fluorouracil/leucovorin therapy are necessary to facilitate the selection of the optimal regimen for each patient.

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