Systemic treatment of patients with advanced pancreatic cancer — is there still a place for gemcitabine in the first-line setting? Experience of Polish oncology centers

Introduction. Despite some progress in the treatment of patients with pancreatic cancer, it is still a malignancy with a poor prognosis, which results from its rapid local growth with a tendency to infiltrate surrounding tissues and metastasize, and late diagnosis at the advanced stage. The use of multi-drug regimens and modern targeted therapies did not completely eliminate the use of gemcitabine in monotherapy, which is a therapeutic option mainly in patients with poor performance status, ineligible for more advanced therapies. This study aimed to evaluate the results of treatment with single-agent gemcitabine in everyday clinical practice in Poland and to attempt to identify the predictors of obtaining long-term responses resulting from this treatment. Material and methods. A retrospective analysis of 167 patients with advanced pancreatic cancer treated with single-agent gemcitabine in five oncology centers in Poland in the years 2017–2022 was conducted. Gemcitabine was used as monotherapy at an initial dose of 1000 mg/m2 of body surface area (BSA) weekly, 7 times in an 8-week cycle, then 3 times in a 4-week cycle. Results. Median overall survival (OS) in the entire group of patients was 6.1 months (range — 0.2–32.3 months), and median progression-free survival (PFS) was 4.2 months (range — 0.2–31.3 months). A group of 60 patients was identified as “long responders” (LR), with a response of at least 6 months and a group of 107 as “short responders” (SR). Median PFS in the LR group was 9.15 months (range — 6.0–31.3 months) and in the SR group, it was 3.2 months (range — 0.2–5.8 months). Median OS was 11.6 months (range — 5.9–30.8) and 3.8 months (range — 0.2–32.3 months), respectively. In multivariate analysis, the likelihood of achieving at least a 6-month response (LR) was assessed using a logistic regression model. The model takes into account four variables: the neutrophil/lymphocyte (NLR) ratio, liver metastases, sex, and Hb level. Conclusions. The obtained results confirm that gemcitabine monotherapy is still useful in the first-line treatment of patients with advanced and metastatic pancreatic adenocarcinoma. An appropriate selection of patients for this treatment may improve the results while maintaining lower toxicity compared to combined treatment.