Second-line therapy for gemcitabine-refractory pancreatic cancer: is there a standard?

Gemcitabine (Gemzar) has been the standard treatment for metastatic pancreatic cancer based primarily on clinical benefits. To date, no standard guideline for second-line treatment of pancreatic cancer has been established. Data supporting the use of second-line therapy compared to best supportive care is lacking. We reviewed the published literature on second-line chemotherapy for pancreatic cancer. Most studies were published in abstract form with small numbers of patients. No single drug has been studied extensively in this setting. Benefits of second-line therapy seem to be modest, at the cost of drug toxicity, and randomized phase III trials are still needed. Future studies in the second-line setting should not only use response or overall survival as an outcome measure but should consider using clinical benefit as treatment endpoints. The incorporation of costs, cost-effectiveness analysis, and cost-benefit analysis into these studies should be considered as well.