Peritoneum carcinomatosis as a favourable prognostic factor for treatment with nanoliposomal irinotecan and fluorouracil plus leucovorin in advanced pancreatic cancer

Abstract

Background: Nanoliposomal irinotecan combined with fluorouracil plus leucovorin (nal-IRI + 5-FU/LV) is a standard second-line treatment for patients with advanced pancreatic cancer. Despite its efficacy, the prognostic factors for treatment efficacy remain unclear in clinical practice. Objectives: To investigate prognostic factors for survival with nal-IRI + 5-FU/LV. Design: Single-centre retrospective cohort. Methods: We included 204 patients who were treated with nal-IRI + 5-FU/LV at our institution between July 2020 and March 2022. These patients had unresectable or recurrent pancreatic adenocarcinoma refractory to a gemcitabine-containing regimen. A Cox regression hazard model was used to explore prognostic factors for overall survival (OS). Results: Of the 204 eligible patients, 127 (64%) had received only one prior treatment. Most patients (90%) had metastatic disease, with 93, 61 and 55 patients having metastases to the liver, lungs and peritoneum, respectively. Among them, 18 patients had peritoneal metastasis without ascites. The median OS and progression-free survival (PFS) were 8.7 (95% confidence interval (CI), 7.5–9.8) and 3.6 (95% CI, 3.0–4.2) months, respectively. An Eastern Cooperative Oncology Group performance status (PS) of 0, serum albumin (Alb) level ⩾3.5 g/dL, C-reactive protein (CRP) level 3.5 g/dL, CRP <0.5 mg/dL, CA 19-9 <1000 U/mL and the presence of peritoneal metastasis, especially without ascites, were favourable prognostic factors for survival in patients with advanced pancreatic cancer treated with nal-IRI + 5-FU/LV.