Second-line therapy for advanced pancreatic cancer: a review of the literature and future directions

Cancer Treat Rev. 2009 Dec;35(8):676-84. doi: 10.1016/j.ctrv.2009.08.012. Epub 2009 Sep 15.


Whereas first-line chemotherapy (CT) with single-agent gemcitabine or gemcitabine-based combinations provides a proven benefit in patients with locally advanced or metastatic pancreatic cancer (PC), the role of salvage CT after gemcitabine-failure is not well-established and to date no regimen has emerged as preferred in this setting. Several clinical trials have investigated the efficacy and toxicity-profile of second-line CT and indicated that selected patients may obtain significant benefit from it, also with regard to survival. However, definitive results from large randomized phase III studies are still lacking, and the evidence for clinical benefit of salvage CT is based on small phase II trials that evaluated different treatment schedules in heterogeneous populations. The main goal of this paper is reviewing this topic.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Antimetabolites, Antineoplastic / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Clinical Trials as Topic / methods
  • Clinical Trials as Topic / statistics & numerical data
  • Deoxycytidine / analogs & derivatives*
  • Deoxycytidine / therapeutic use
  • Drug Resistance, Neoplasm
  • Fluorouracil / administration & dosage
  • Gemcitabine
  • Humans
  • Leucovorin / administration & dosage
  • Middle Aged
  • Organoplatinum Compounds / administration & dosage
  • Oxaliplatin
  • Pancreatic Neoplasms / drug therapy*
  • Pancreatic Neoplasms / pathology
  • Platinum Compounds / administration & dosage
  • Predictive Value of Tests
  • Prognosis
  • Research Design
  • Risk Assessment
  • Risk Factors
  • Salvage Therapy / methods*
  • Survival Analysis


  • Antimetabolites, Antineoplastic
  • Organoplatinum Compounds
  • Platinum Compounds
  • Oxaliplatin
  • Deoxycytidine
  • Leucovorin
  • Fluorouracil
  • Gemcitabine