Modified gemcitabine, S-1, and leucovorin combination for patients with newly diagnosed locally advanced or metastatic pancreatic adenocarcinoma: A multi-center retrospective study in Taiwan

Abstract

Background In pancreatic cancer, toxicities associated with current chemotherapeutic regimens remain concerning. A modified combination of gemcitabine, S-1, and leucovorin (GSL) was used as the first-line treatment for newly diagnosed locally advanced or metastatic pancreatic adenocarcinoma patients. Methods GSL was administered every 2 weeks—intravenous gemcitabine 800 mg/m2 at a fixed-dose rate of 10 mg/m2/min on day 1 and oral S-1 (80–120 mg/day) plus leucovorin 30 mg twice daily on days 1–7. We retrospectively analyzed the feasibility of GSL and patient outcomes in three medical centers in Taiwan. Results Overall, 49 patients received GSL with a median follow-up of 24.9 months from May 2015 to March 2019. The median patient age was 68 years (range, 47–83 years), with a marginally higher number of females (57.1%). Among the 44 patients who underwent image evaluation, 13 demonstrated a partial response (29.5%) and 17 presented with stable disease (38.6%). The partial response rate and stable disease rate was 26.5% and 34.7%, respectively, in the intent-to-treat analysis. The median time-to-treatment failure was 5.79 months (95% C.I., 2.63–8.94), progression-free survival was 6.94 months (95% C.I., 5.55–8.33), and overall survival time was 11.53 months (95% C.I., 9.94–13.13). For GSL treatment, the most common grade 3 or worse toxicities were anemia (18.3%), neutropenia (6.1%), nausea (4.1%), and mucositis (4.1%). Treatment discontinuation was mostly due to disease progression (65.3%). Conclusions The modified GSL therapy can be a promising and affordable treatment for patients with advanced and metastatic pancreatic cancer in Taiwan. A prospective trial of modified GSL for elderly patients is currently ongoing in Taiwan.