Gemcitabine-Capecitabine Chemotherapy Plus Intra-Arterial Epirubicin-Cisplatin in Pancreatic Cancer Patients after FOLFIRINOX First Line Chemotherapy: A Retrospective Analysis

Background: Most pancreatic cancer patients have disease recurrence/progression within 6 months from firstline chemotherapy end. Today, there is no a standard of care of second-line therapy. Materials (patients) and methods: We retrospectively collected data of 41 locally advanced/metastatic pancreatic cancer patients underwent to FOLFIRINOX first line chemotherapy and subsequently treated with Gemcitabine-Capecitabine chemotherapy plus Intraarterial Epirubicin-Cispatin (EC-GEMCAP). Results: Treatment was well tolerated, without dose reductions or delays. Hematologic and no hematologic grade 3-4 toxicities were 39% and 12.2%. Twenty, 2 and 12 patients obtained a stability/partial response/progression disease respectively, with a disease control rate in 22 patients. One patient with locally advanced disease underwent to radically surgery after 6 cycles of EC-GEMCAP. Median OS was 16.9 months (95% CI: 14.7-19.0) with OS rates at 6, 12 and 24 months of 95.1%, 80.5% and 31.7%. As regards second-line therapy, median OS was 8.9 months (95% CI: 6.9-10.9). OS rates at 6, 12 and 24 months were 61%, 80.5% and 31.7%. EC-GEMCAP median PFS was 4.1 months (95% CI: 3.1-5.1). PFS rates at 6 and 12 months were 41.5% and 19.5%. Conclusions: EC-GEMCAP proved to be a viable treatment in terms of toxicity and activity and it could be considered a therapeutic option also in poor performance status patients.