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Background Since the introduction of nab-paclitaxel plus gemcitabine (nab-P + GEM) as first-line (1L) treatment for metastatic pancreatic adenocarcinoma (mPDAC), optimal second-line (2L) chemotherapy after progression is unclear. We assessed clinical outcomes of 2L chemotherapy for disease that progressed on 1L nab-P + GEM. Methods Among the 203 patients previously treated with 1L nab-P + GEM for mPDAC at Asan Medical Center, between February and December 2016, records of 120 patients receiving 2L chemotherapy after progression on nab-P + GEM were retrospectively reviewed. The response rate and survival were evaluated along with analysis of prognostic factors. Results Fluoropyrimidine-oxaliplatin doublets (FOLFOX or XELOX) were used in 78 patients (65.0%), fluoropyrimidine monotherapy in 37 (30.8%), and liposomal irinotecan plus fluorouracil in 2 (1.7%). The median progression-free survival (PFS) and overall survival (OS) were 3.29 months and 7.33 month from the start of 2L therapy. Fluoropyrimidine-oxaliplatin regimens and fluoropyrimidine monotherapy did not yield significantly different median PFS (2.89 vs 3.81 months, P = 0.40) or OS (7.04 vs 7.43 months, P = 0.86). A high neutrophil-lymphocyte ratio (>2.2) and a short time to progression with 1L nab-P + GEM ( Conclusions 2L fluoropyrimidine-oxaliplatin doublets and fluoropyrimidine monotherapy after failure of 1L nab-P + GEM had modest efficacy, with no differences in treatment outcomes between them. Further investigation is warranted for the optimal 2L chemo-regimens and sequencing of systemic chemotherapy for patients with mPDAC. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

ESMO 20th World Congress on Gastrointestinal Cancer -- JUN 20-23, 2018 -- Barcelona, SPAIN, WOS: 000439970900151, European Soc Med Oncol

e14570 Background: Gastric cancer is a frequent malignancy with worldwide estimated incidence of 990,000 cases, representing 7.8% of all cancers in 2008. There are limited data suggesting a benefit for doublet second-line chemotherapy in advanced gastric cancer. Methods: The eligibility criteria were patients 1) with prior exposure to cisplatin based chemotherapy and advanced or recurrent stomach cancer 2) with pathologically proven gastric adenocarcinoma, 3) with an ECOG performance status 0 to 2, 4) with measurable lesions. Each treatment cycle was consisted of docetaxel 36 mg/m2 in docetaxel mono therapy group and docetaxel 36 mg/m2, oxaliplatin 80 mg/m2 in docetaxel/oxaliplatin doublet therapy group on days 1, 8. The primary end point of this study was response rate, and secondary end points included toxicity, progression free and overall survival. Results: Fifty two patients were enrolled; median age was 63 years; male (n=42) and female (n=10); docetaxel mono therapy (n=27) and docetaxel/oxalliplatin doublet therapy (n=25). The median number of cycles administered was 2.5 (range,1-9). Fourty eight patients were assessable for efficacy. Four partial responses, 7 stable diseases in mono therapy group (RR; 4/27, 14.8%) and 1 complete remission, 4 partial responses, 13 stable diseases in double therapy group (RR; 5/25, 20.0%) were confirmed (p=0.198). Median progression free survival was 1.97 months in the mono therapy group and 4.93 months in doublet therapy group (p=0.007). Median overall survival was 11.57 months in the mono therapy group and 8.13 months in doublet therapy group (p=0.650). Grade 3 or 4 adverse events were reported in 11 of 52 patients; G3 pain were in 2 patients and G3 pneumonia was in 1 patient in mono group, G3/4 neutropenia were 5 patients in the combination group, G3 nausea, vomiting, general weakness was 1 patient each group in combination group. Conclusions: Weekly docetaxel/oxaliplatin doublet therapy showed superior progression free survival to monotherapy group as second line therapy in cisplatin pretreated advanced gastric cancer patients.

624 Background:Previously, five prognostic factors (ECOG PS 2, pathologically poorly differentiated adenocarcinoma, peritoneal metastasis, PFS of 1st-line therapy 400 IU/L) were identified in 124 patients with metastatic colorectal cancer who received irinotecan-based second-line chemotherapy (Shitara K, et al. ASCO-GI 2009). Patients were categorized into three prognostic groups (low-risk = no factors, intermediate-risk = 1 factor, high-risk = 2 or more factors), with significant differences in median overall survival (23.5, 14.6, and 5.5 months, respectively). The purpose of this study was to validate this prognostic classification in an external validation cohort. Methods: We retrospectively analyzed 198 patients with metastatic colorectal cancer who received irinotecan-based second-line chemotherapy after first-line oxaliplatin-based chemotherapy in 3 institutions. This was our validation cohort. Results: The median overall survival of this validation cohort was not significantly different from that of the generating cohort (12.1 vs. 14.6 months; P=0.47). The distribution of the three prognostic groups in the validation cohort was as follows: low-risk (n=68; 35%), intermediate-risk (n=80; 41%), high-risk (n=45; 23%), with a higher proportion of intermediate-risk patients in comparison with the generating cohort. The median overall survival of each prognostic group in the validation cohort was 19.8, 11.0, and 7.9 months, respectively, with significant differences among groups (P Conclusions: Our results validated the previously defined prognostic classifications in patients with metastatic colorectal cancer who received irinotecan-based second-line chemotherapy. This classification may be useful as a stratification factor in clinical trials or in considering treatment strategies for individual patients.

Introduction Successful treatment of HRGTN patients is related to experienced teams, adequate scoring and standard treatments. Chemotherapy is the cornerstone of therapy and the dose and timing has paramount importance. Objectives To evaluate the prognostic significance of IMI on mortality and morbidity in HRGTN setting. Methods Were reviewed clinical records of consecutive patients with gestational trophoblastic diseases who where evaluated and treated at Durand Hospital from 1990 to 2012. We selected HRGTN patients in two groups. Group 1, with IMI; and Group 2, without IMI. Results Three hundred fifty eight patients (pts) were recorded. Patients with HRGTN were 34 (9.49 %),median age 29 (r.14-42),median FIGO/OMS scoring were 11. Group 1 (21 pts) achieved cure (85.7%) with 2-6 lines of chemotherapy (median 4); three deaths were seen and all patients suffered grade 4 toxicity. Group 2 (13 pts) achieved cure (100%) with only one pt with second line chemotherapy, no grade 4 toxicity and no related mortality. Conclusions The IMI was an adverse prognostic factor and was related to increased toxicity. HRGTN is a curable disease. Patients with high-risk gestational trophoblastic neoplasia should be managed in consultation with individuals or facilities with expertise in the complex, multimodality treatment of these patients. Disclosure All authors have declared no conflicts of interest.

7 mg/m 2 every 6 weeks and infusional 5-FU 300 mg/m 2 /24 hours; the treatment was continued for 24 weeks or until evidence of treatment failure. The results are interesting, with three partial responses (12%), two minor responses (8%), five stabilizations of disease (21%), and a median survival of nine months. In our department we are treating patients with advanced colorectal cancer who progressed after a first-line chemotherapy, with bolus mitomycin C 10 mg/m 2 every six weeks, and continuous infusion of 5-FU 200 mg/m 2 and 1-folinic acid 10 mg/m 2