Pancreatic cancer treatment after FOLFIRINOX: prognostic importance of chemotherapy dose intensity and albumin/globulin ratio in second line

Year 2022, Volume: 5 Issue: 1, 156 - 160, 17.01.2022

Özgen Ahmet Yıldırım , Erkan Erdur

https://doi.org/10.32322/jhsm.1011658

Abstract

Aim: Pancreatic adenocarcinoma (PA) is the seventh most common cause of cancer-related mortality. Our primary endpoint of study was to determine the relationship between albumin/globulin ratio (AGR) and progression-free and overall survival (PFS and OS) in second-line treatment after FOLFIRINOX. Our secondary endpoint was to assess treatment side effects and the relationship of treatment dose intensity with treatment type and AGR.
Material and Method: PA patients who followed-up between January 2014 and January 2021 were evaluated retrospectively. Age, gender, ECOG score and AGR recorded at the beginning of the second-line treatment. Thrombocytopenia, neutropenia, chemotherapy type, chemotherapy dose intensity, PFS and OS were recorded during the second-line treatment.
Results: Median age 64 (44-80), 72 (70.6%) male, 102 metastatic PA patients were evaluated. 76 (74.5%) patients were ECOG 0-1, 26 (25.5%) patients were ECOG 2. Of these patients in the second step, 68 (66.7%) received single-agent gemcitabine and 34 (33.3%) received Nab-paclitaxel + gemcitabine treatment. Progression and exitus events occurred in all cases. Median PFS was 166.8 days in the AGR>1.2 group, it was 80.7 days in the AGR<1.2 group (p=0.003). While the median OS was 295.7 days in the AGR>1.2 group, it was 144 days in the AGR<1.2 group (p=0.041). Dose intensity was 80.7% in the AGR>1.2 group, it was 71.3% in the AGR<1.2 group (p=0.002).
Conclusion: Even with palliative and advanced treatment, achieving a dose density close to 80% is a good prognostic indicator. AGR is a prognostic marker that remains effective in advanced stages of PA.

Keywords

pancreatic cancer, dose intensity, albumin globulin ratio

Supporting Institution

none

Project Number

no funding received

References

• Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394–424.
• Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol 2019; 10: 10–27.
• Capasso M, Franceschi M, Rodriguez-Castro KI, et al. Epidemiology and risk factors of pancreatic cancer. Acta Bio Medica Atenei Parm 2018; 89: 141–6.
• McGuigan A, Kelly P, Turkington RC, Jones C, Coleman HG, McCain RS. Pancreaticcancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol 2018; 24: 4846–61.
• Stjepanovic N, Moreira L, Carneiro F, et al. Hereditary gastrointestinal cancers: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol 2019; 30: 1558–71.
• ESMO Guidelines Committee. eUpdate – Cancer of the Pancreas Treatment Recommendations, https://www.esmo.org/guidelines/gastrointestinal-cancers/pancreatic-cancer/eupdate-cancer-of-the-pancreas-treatment-recommendations; 2019; 1
• Ghaneh P, Palmer DH, Cicconi S, et al. ESPAC-5F: Four-arm, prospective, multicenter, international randomized phase IItrial of immediate surgery compared with neoadjuvant gemcitabine pluscapecitabine (GEMCAP) or FOLFIRINOX or chemoradiotherapy (CRT) in patients with borderline resectable pancreatic cancer. J Clin Oncol 2020; 38: 4505.
• Katz MHG, Shi Q, Meyers JP, et al. Alliance A021501: Preoperative mFOLFIRINOX or mFOLFIRINOX plus hypofractionated radiation therapy (RT) for borderline resectable (BR) adenocarcinoma of the pancreas. J Clin Oncol 2021; 39: 377.
• Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011; 364: 1817–25.
• Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 2013; 369: 1691–703.
• Portal A, Pernot S, Tougeron D, et al. Nab-paclitaxel plus gemcitabine for metastatic pancreatic adenocarcinoma after Folfirinox failure: an AGEO prospective multicentre cohort. Br J Cancer 2015; 113: 989–95.
• Wang-Gillam A, Li C-P, Bodoky G, et al. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. The Lancet 2016; 387: 545–57.
• Akhoundova Sanoyan D, Reiner CS, Papageorgiou P, Siebenhüner AR. Sequential treatment of metastatic adenocarcinoma of the pancreatic duct with liver metastasis following the NAPOLI-1 study protocol with nal-irinotecan plus 5-FU in the second line. Case Reps Oncol 2020; 13: 79–84.
• Nielson CM, Bylsma LC, Fryzek JP, Saad HA, Crawford J. Relative dose intensity of chemotherapy and survival in patients with advanced stage solid tumor cancer: a systematic review and meta-analysis. Oncologist. 2021;9:1609-18.
• McMillan DC, Watson WS, O'Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001; 2: 210-3.
• Meyer EJ, Nenke MA, Rankin W, Lewis JG, Torpy DJ. Corticosteroid-binding globulin: a review of basic and clinical advances. Horm Metab Res 2016; 6: 359-71.
• Lv GY, An L, Sun XD, Hu YL, Sun DW. Pretreatment albumin to globulin ratio can serve as a prognostic marker in human cancers: a meta-analysis. Clin Chim Acta 2018; 476: 81-91.
• Cherri S, Noventa S, Zaniboni A. Pancreatic adenocarcinoma: Beyond first line, where are we? World J Gastroenterol 2021; 3: 1847-63.
• Leader A, Hofstetter L, Spectre G. Challenges and advances in managing thrombocytopenic cancer patients. J Clin Med. 2021; 10: 1169.
• Turker S, Cilbir E, Guven DC, Karacin C, Yalcin S. The relation between inflammation-based parameters and survival in metastatic pancreatic cancer. J Cancer Res Ther. 2021; 17: 510-5.
• Toledano-Fonseca M, Cano MT, Inga E, et al. The combination of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with liquid biopsy biomarkers ımproves prognosis prediction in metastatic pancreatic cancer. Cancers (Basel) 2021; 13: 1210.
• Tezuka K, Okamura Y, Sugiura T, et al. Predictive factors of survival in patients with borderline resectable pancreatic cancer who received neoadjuvant therapy. Pancreatology. 2021;8:1424-903.
• Pradere B, D'Andrea D, Schuettfort VM, et al. UTUC collaboration. Pre-therapy serum albumin-to-globulin ratio in patients treated with neoadjuvant chemotherapy and radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol. 2021;7:2567-77.
• Feng L, Gu S, Wang P, et al. Pretreatment values of bilirubin and albumin are not prognostic predictors in patients with advanced pancreatic cancer. Cancer Med 2018; 7: 5943-51.
• Liu J, Chen S, Geng Q, et al. Prognostic value of pretreatment albumin-globulin ratio in predicting long-term mortality in gastric cancer patients who underwent D2 resection Onco Targets Ther 2017; 10: 2155-62.