Investigational New Drugs

, Volume 36, Issue 5, pp 939–948 | Cite as

Post-progression survival following second-line chemotherapy in patients with advanced pancreatic cancer previously treated with gemcitabine: a meta-analysis

  • Akiyoshi Kasuga
  • Yasuo Hamamoto
  • Ayano Takeuchi
  • Naohiro Okano
  • Kazuhiro Togasaki
  • Yu Aoki
  • Takeshi Suzuki
  • Kenta Kawasaki
  • Kenro Hirata
  • Yasutaka Sukawa
  • Takanori Kanai
  • Hiromasa Takaishi


Background Post-progression survival (PPS) could be a confounding element in interpreting data from clinical trials of second-line chemotherapy in patients with advanced pancreatic cancer (PC) previously treated with gemcitabine (GEM) because a recent meta-analysis of oxaliplatin combination therapy showed statistical heterogeneity for overall survival (OS) but not for progression-free survival (PFS). This study aimed to improve the understanding of the impact of PPS on OS in this setting. Methods Databases were searched to identify randomized controlled trials (RCTs) in the salvage setting. We evaluated relationships between OS and PFS, PPS, and other variables. Results Totally, 17 RCTs with 3253 patients were identified. Median OS was strongly and moderately associated with median PPS and PFS, respectively (r = 0.913; p < 0.001 and 0.780; p < 0.001, respectively). The proportion of patients with good performance status was significantly associated with both PPS and PFS (r = 0.574, p < 0.001 and 0.492, p < 0.001, respectively). The induction rate of subsequent chemotherapy was related to the duration of PPS and OS (r = 0.640, p < 0.001 and 0.647, p < 0.001, respectively). Median PPS and OS were significantly longer in recent trials than those in older trials (3.55 versus 2.78 months, p < 0.001 and 6.29 versus 5.02 months, p < 0.001). Conclusions Median PPS was strongly correlated with median OS. Given the recently increased opportunity for subsequent chemotherapy and supportive care, PPS may serve as an important element to clarify problems in this setting.


Pancreatic cancer Meta-analysis Randomized controlled trial Second-line chemotherapy Salvage chemotherapy Post-progression survival 


Compliance with ethical standards

Conflict of interest

All authors declare no Conflicts of Interests for this article.

Takanori Kanai received research grants from Astellas Pharm Inc., Astra-Zeneca K.K., Otsuka Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd., Eisai Pharmaceutical Co. Ltd., Zeria Pharmaceutical Co. Ltd., Tanabe Mitsubishi Pharmaceutical Co. Ltd., JIMRO Co. Ltd., Kyorin Pharmaceutical Co. Ltd., and received service honoraria from Astellas Pharm Inc., Eisai Pharmaceutical Co. Ltd., JIMRO Co. Ltd., Tanabe Mitsubishi Pharmaceutical Co. Ltd., Otsuka Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd., Miyarisan Pharmaceutical Co. Ltd., and Zeria Pharmaceutical Co. Ltd. Hiromasa Takaishi received research grants from Taiho Pharmaceutical Co. Ltd., and Yakult Honsha Pharmaceutical Co. Ltd., outside the submitted work.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

We did not use individual data but published data. These data have been widely utilized in research and are generally available. Therefore, we confirm that any aspect of the work covered in this manuscript has been conducted with ethical approval. And this study is registered in the PROSPERO database (CRD42017071274) and was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) statement.


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

Authors and Affiliations

  • Akiyoshi Kasuga
    • 1
  • Yasuo Hamamoto
    • 1
  • Ayano Takeuchi
    • 2
  • Naohiro Okano
    • 3
  • Kazuhiro Togasaki
    • 1
  • Yu Aoki
    • 1
  • Takeshi Suzuki
    • 1
  • Kenta Kawasaki
    • 1
  • Kenro Hirata
    • 1
  • Yasutaka Sukawa
    • 1
  • Takanori Kanai
    • 1
  • Hiromasa Takaishi
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of MedicineKeio UniversityTokyoJapan
  2. 2.Department of Preventive Medicine and Public Health, School of MedicineKeio UniversityTokyoJapan
  3. 3.Department of Clinical Oncology, School of MedicineKyorin UniversityTokyoJapan

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