Journal of Gastrointestinal Cancer

, Volume 50, Issue 4, pp 860–866 | Cite as

Second-Line Treatment for Advanced Pancreatic Adenocarcinoma: Is There a Role for Gemcitabine?

  • Daniel M. GirardiEmail author
  • Luiza Dib B. B. Faria
  • Marcela C. Teixeira
  • Frederico P. Costa
  • Paulo Marcelo G. Hoff
  • Gustavo S. Fernandes
Original Research



Advanced pancreatic adenocarcinoma (PA) is an aggressive disease that has poor prognosis and frequently interferes with patient’s quality of life. There has been progress in first-line regimens; however, there is no standard second-line regimen. The aim of this study is to analyze second-line gemcitabine after first-line fluorouracil (FU) + leucovorin (LV) + irinotecan + oxaliplatin (FOLFIRINOX) regimen.


This study included consecutive patients with advanced PA treated at Hospital Sirio-Libanês from 2011 to 2016. The patients received FOLFIRINOX as first-line treatment and upon progression, received gemcitabine alone. Survival analysis was performed using the Kaplan-Meier method.


A total of 54 patients were evaluated. Most patients were male (61.1%) and most had an ECOG performance status of 0 or 1 prior to the beginning of second-line treatment (66.6%). The mean number of gemcitabine cycles was 3.4. Most patients had disease progression as the best response to treatment (75.9%), 11.1% had stable disease, and 9.3% experienced a partial response. The median progression-free survival was 1.7 months, and the median overall survival was 6.8 months.


Gemcitabine alone did not show meaningful clinical benefit as second-line treatment after FOLFIRINOX.


Gemcitabine FOLFIRINOX Second-line treatment Pancreatic 



The Oncology Center of Hospital Sírio-Libanes supported this work.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of Interest

Gustavo dos Santos Fernandes has received grants for consulting or Advisory Role from Roche, has received a speaker honorarium from Roche, has provided expert testimony for Novartis, and received travel accommodations and expenses from Roche. The rest of the authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OncologyHospital Sírio-LibanesBrasíliaBrazil
  2. 2.Instituto do Câncer do Estado de São PauloFaculdade de Medicina da Universidade de São PauloSão PauloBrazil

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