Docetaxel second-line therapy in patients with advanced pancreatic cancer: a retrospective study

No therapeutic standard of care exists for patients who have progressed following first-line treatment with a gemcitabine-based regimen with advanced pancreatic cancer. Approximately half of the patients failing upfront treatment present with ECOG PS 1-2 and are willing to undergo further treatment. Docetaxel activity against pancreatic cancer is reported both in the preclinical and clinical setting. This study retrospectively evaluated the role of docetaxel as second-line therapy in patients with gemcitabine-refractory disease.

Between January 2006 and November 2009, 17 patients (median age of 61 years) with advanced pancreatic adenocarcinoma, after receiving gemcitabine-containing chemotherapy as first-line median ECOG performance status 1 and with adequate organ function, were treated with either weekly docetaxel at 25 mg/m(2) or 3-weekly docetaxel regimen (docetaxel at 75 mg/m(2) or docetaxel-gemcitabine-capecitabine or docetaxel-gemcitabine) until progressive disease. Serum CA19-9 levels were measured every 3/4 weeks and CT scans performed after every eight/nine weeks.

Docetaxel dose intensity was 90% in the patients who received weekly docetaxel, 85% in docetaxel-erlotinib regimen and 65% in 3-weekly regimen (docetaxel-gemcitabine-capecitabine, docetaxel-gemcitabine). Only one objective response (6%) to treatment was obtained (docetaxel-gemcitabine), while 5 patients achieved stable disease (weekly docetaxel). Median progression-free survival was 8 weeks (range: 3-16 weeks) and median survival was 4.0 months (range: 2.0-6.5 months). No toxicity with grade >3 associated with docetaxel was observed.

Docetaxel seems to have mild activity in the treatment of gemcitabine-resistant metastatic pancreatic cancer. Although some patients may benefit from the treatment, other dosing regimens and novel taxanes such as Nab-paclitaxel should be explored in this setting.