Performance Status is an Important Prognostic Factor in Second Line Treatment of Pancreaticobiliary Adenocarcinoma

Abstract

Background/Aims: To define the factors related with disease control and survival in patients with pancreaticobiliary adenocarcinoma treated with second-line therapy. Methodology: We retropectively reviewed the data of 39 pancreaticobiliary adenocarcinoma patients treated with second-line chemotherapy between 2000 and 2012. Age, gender, origin of tumor, location of tumor, stage at diagnosis, Eastern Cooperative Oncology Group (ECOG) performance status, progression site, progression free survival (PFS) for first-line therapy, disease control at first-line therapy and chemotherapy protocols are analyzed for disease control rate, PFS and overall survival (OS). Results: Disease control was recorded in 21 (53.8%) patients (20 stable disease, 1 partial response). Disease control rate was higher in patients with good performance status (p=0.03). Disease control at first-line therapy was not a predictor of disease control at second-line (p=0.6). Response to first-line therapy and other prognostic factors was not related with disease control. Progression free survival and OS was significantly longer in patients with good ECOG performance status (0-1) (p=0.01, p=0.006). Choice of chemotherapy (single agent or combination) and other factors did not have any impact on PFS and OS. In multivariate analysis; disease control was independent prognostic factor for both PFS and OS (p<0.001), (p<0.001). Conclusions: Disease control and performance status are two important prognostic factors. Chemotherapy regimen has no impact on disease control and survival. Salvage chemotherapy can be considered for patients with good performance status whether they are resistant to first-line therapy or not.