Clinical characteristics and blood/serum bound prognostic biomarkers in advanced pancreatic cancer treated with gemcitabine and nab-paclitaxel
Background: In recent years treatment options for advanced pancreatic cancer has markedly improved, and a combination regimen of gemcitabine and nab-paclitaxel is now considered standard of care in Sweden and elsewhere. Nevertheless, a majority of patients do not respond to treatment. In order to guide the individual patient to the most beneficial therapeutic strategy, simple and easily available prognostic and predictive markers are needed.
Methods: The potential prognostic value of a range of blood/serum parameters, patient-, and tumour characteristics was explored in a retrospective cohort of 75 patients treated with gemcitabine/nab-paclitaxel (Gem/NabP) for advanced pancreatic ductal adenocarcinoma (PDAC) in the South Eastern Region of Sweden. Primary outcome was overall survival while progression free survival was the key secondary outcome.
Result: Univariable Cox regression analysis revealed that high baseline serum albumin (> 37 g/L) and older age (>65) were positive prognostic markers for OS, and in multivariable regression analysis both parameters were confirmed to be independent prognostic variables (HR 0.48, p=0.023 and HR=0.47, p=0.039,). Thrombocytopenia at any time during the treatment was an independent predictor for improved progression free survival (PFS) but not for OS (HR 0.49, p=0.029, 0.54, p=0.073), whereas thrombocytopenia developed under cycle 1 was neither related with OS nor PFS (HR 0.87, p=0.384, HR 1.04, p=0.771). Other parameters assessed (gender, tumour stage, ECOG performance status, myelosuppression, baseline serum CA19-9, and baseline serum bilirubin levels) were not significantly associated with survival.
Conclusion: Serum albumin at baseline is a prognostic factor with palliative Gem/NabP in advanced PDAC, and should be further assessed as a tool for risk stratification. Older age was associated with improved survival, which encourages further studies on the use of Gem/NabP in the elderly.
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Posted 18 Sep, 2020
On 13 Aug, 2020
On 12 Aug, 2020
On 12 Aug, 2020
On 03 Aug, 2020
Received 31 Jul, 2020
On 15 Jul, 2020
Received 08 Mar, 2020
On 02 Mar, 2020
Invitations sent on 02 Mar, 2020
On 28 Jan, 2020
On 27 Jan, 2020
On 27 Jan, 2020
Received 13 Jan, 2020
On 13 Jan, 2020
Received 11 Jan, 2020
On 01 Jan, 2020
On 26 Dec, 2019
Invitations sent on 24 Dec, 2019
On 12 Dec, 2019
On 10 Dec, 2019
On 09 Dec, 2019
On 02 Dec, 2019
Clinical characteristics and blood/serum bound prognostic biomarkers in advanced pancreatic cancer treated with gemcitabine and nab-paclitaxel
Posted 18 Sep, 2020
On 13 Aug, 2020
On 12 Aug, 2020
On 12 Aug, 2020
On 03 Aug, 2020
Received 31 Jul, 2020
On 15 Jul, 2020
Received 08 Mar, 2020
On 02 Mar, 2020
Invitations sent on 02 Mar, 2020
On 28 Jan, 2020
On 27 Jan, 2020
On 27 Jan, 2020
Received 13 Jan, 2020
On 13 Jan, 2020
Received 11 Jan, 2020
On 01 Jan, 2020
On 26 Dec, 2019
Invitations sent on 24 Dec, 2019
On 12 Dec, 2019
On 10 Dec, 2019
On 09 Dec, 2019
On 02 Dec, 2019
Background: In recent years treatment options for advanced pancreatic cancer has markedly improved, and a combination regimen of gemcitabine and nab-paclitaxel is now considered standard of care in Sweden and elsewhere. Nevertheless, a majority of patients do not respond to treatment. In order to guide the individual patient to the most beneficial therapeutic strategy, simple and easily available prognostic and predictive markers are needed.
Methods: The potential prognostic value of a range of blood/serum parameters, patient-, and tumour characteristics was explored in a retrospective cohort of 75 patients treated with gemcitabine/nab-paclitaxel (Gem/NabP) for advanced pancreatic ductal adenocarcinoma (PDAC) in the South Eastern Region of Sweden. Primary outcome was overall survival while progression free survival was the key secondary outcome.
Result: Univariable Cox regression analysis revealed that high baseline serum albumin (> 37 g/L) and older age (>65) were positive prognostic markers for OS, and in multivariable regression analysis both parameters were confirmed to be independent prognostic variables (HR 0.48, p=0.023 and HR=0.47, p=0.039,). Thrombocytopenia at any time during the treatment was an independent predictor for improved progression free survival (PFS) but not for OS (HR 0.49, p=0.029, 0.54, p=0.073), whereas thrombocytopenia developed under cycle 1 was neither related with OS nor PFS (HR 0.87, p=0.384, HR 1.04, p=0.771). Other parameters assessed (gender, tumour stage, ECOG performance status, myelosuppression, baseline serum CA19-9, and baseline serum bilirubin levels) were not significantly associated with survival.
Conclusion: Serum albumin at baseline is a prognostic factor with palliative Gem/NabP in advanced PDAC, and should be further assessed as a tool for risk stratification. Older age was associated with improved survival, which encourages further studies on the use of Gem/NabP in the elderly.
Figure 1
Figure 2
Figure 3