SYMPTOMATIC CHANGES TO PREDICT DISEASE CONTROL BY CHEMOTHERAPY FOR PANCREATIC CANCER

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Abstract

Background

Alleviation of symptoms is related to good tumor control in patients undergoing systemic chemotherapy for pancreatic cancer (PC). The predictive value of symptomatic changes has not been fully understood. The aim of this study was to identify symptomatic changes to predict disease control by chemotherapy in PC patients (pts).

Methods

Pts with unresectable PC who had not received any anti-cancer therapy for PC were eligible for inclusion in this study. Pts with obvious infectious conditions were excluded. The symptoms and tumor markers of pts were prospectively assessed. Symptoms were scored from 0 to 10 using the Japanese version of the MD Anderson Symptom Inventory before the start of chemotherapy and one month later. The tumor response was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) ver. 1.0. Disease control was defined as CR, PR, or SD. An attempt was made to identify symptom changes that predicted disease control, and their impact on progression-free survival (PFS) was assessed.

Results

The number of pts was 87 (male/female: 46/41, Karnofsky performance status (KPS): 100/90/80/70-50: 32/29/17/9, median age: 66 years). Gemcitabine monotherapy (GEM), a GEM-based regimen, and S-1 monotherapy were carried out in 42, 41, and 4 patients, respectively. Disease control was observed in 31 patients. The rate of disease control was lower in pts with worsened sleep disturbance, distress, increased dose of morphine and CA19-9 than in pts without them (P = 0.004, P = 0.041, P = 0.015, P < 0.001, respectively). The multivariate analysis revealed that the worsened sleep disturbance (Odds ratio 3.94, P = 0.035) and increased CA19-9 (Odds ratio 3.63, P = 0.054) was the predictive marker in poor disease control by chemotherapy. And the area under the ROC curve to diagnose disease control using worsened sleep disturbance (0.682) was similar with that using increased CA 19-9 (0.665).

Conclusions

The worsened sleep disturbance can predict poor disease control in PC pts undergoing chemotherapy.

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