Paclitaxel as weekly second-line therapy in patients with advanced pancreatic carcinoma

Although the prognosis for patients with pancreatic adenocarcinoma is still poor, gemcitabine has shown significant impact upon survival and quality o f life. Our aim was to examine the potential effectiveness of a second- or third-line therapy with paclitaxel (Taxol(R)) after confirmed progression w ith a gemcitabine-containing schedule for patients remaining in good clinic al condition, Eighteen patients with stage IVb disease participated in this study. Pretreatment with gemcitabine was performed either as monotherapy a nd/or in combination with 5-fluorouracil (5-FU) and folic acid (FA). Paclit axel was administered at weekly intervals on an outpatient basis. We observ ed 238 weekly treatments with a median number per patient of 12 treatments. The median dosage was 73 mg/m(2) paclitaxel (range 55-88 mg/m(2)). Regardi ng toxicity, only one patient each presented with anemia and leukocytopenia of WHO grade III. Hepatotoxicity with a temporary Increase in aminotransfe rase of WHO grade II occurred In three patients. Higher-grade symptomatic t oxicity was rare, except alopecia, At this time, the median survival time i s 17.5 weeks (range 7-88 weeks) since the start of therapy. Stable disease was observed in five patients. One patient achieved complete remission with in 37 weeks. At this time, he has survived for more than 56 weeks after con firmed progression under first-line therapy. In conclusion, this schedule d emonstrates that weekly therapy with paclitaxel after pretreatment can be e ffective with a low toxicity profile. This opens up an additional therapeut ic option for a selected patient group with a poor prognosis so far. [(C) 2 000 Lippincott Williams & Wilkins.].