After failure of first line therapy, however, the options continue to be even more limited. There are currently no widely accepted treatments beyond first line. The only regimen to show evidence of survival benefit in a context of a randomized trial in this setting is oxaliplatin/5-FU/leucovorin (OFF), which improved overall survival to

4.8 months from 2.3 months with best supportive care (4). Nab-paclitaxel (trade name, Abraxane), is paclitaxel bound to nano-particle albumin, a first drug of this type. Inhibitors,research,lifescience,medical Nab-paclitaxel was initially developed to avoid hypersensitivity reactions that resulted from solvents such as cremephor that are used to dissolve paclitaxel. Nab-paclitaxel has been approved by the Food and Drug Inhibitors,research,lifescience,medical Administration since 2004 for use in metastatic breast cancer as well as metastatic non-small cell lung cancer (5,6). In addition to eliminating hypersensitivity reaction, it has also been postulated that uptake of albumin by tumor cells may allow improved intra-tumoral delivery of nab-paclitaxel. This may be especially relevant in pancreatic cancer given the dense stromal component of this malignancy

that has been postulated as being central to its chemoresistance (7). In fact, a protein present in stroma of many pancreatic adenocarcinomas, secreted protein Inhibitors,research,lifescience,medical acidic and rich in cysteine (SPARC), may help serve as an albumin-binding Inhibitors,research,lifescience,medical protein that sequesters nab-paclitaxel to concentrate the drug intratumorally (8). Nab-paclitaxel was first used in pancreatic cancer two years ago in combination with gemcitabine in the setting of a phase I-II study, where it was found to be tolerable with substantial activity (9). The results of a phase III trial comparing gemcitabine to gemcitabine combined with nab-paclitaxel were recently presented in abstract form showing improved

survival of two months from 6.7 to 8.5 months with the combination Inhibitors,research,lifescience,medical therapy in previously untreated patients with advanced pancreatic cancer (10). In the second line setting, a small phase II study has also shown evidence of activity of nab-paclitaxel monotherapy in patients who have progressed through gemcitabine (11). This study involved 19 patients and showed an overall survival of 7.3 months. 36.8% of patients had stable or partial response on best imaging in this study. No other data is available, to the best of Dacomitinib our knowledge, however, on the use of nab-paclitaxel monotherapy in refractory pancreatic cancer, which is an area of dire need. Here, we report the results of a retrospective and selleck chem Cisplatin prospective registry study documenting our experience with nab-paclitaxel monotherapy in heavily pretreated pancreatic cancer patients. Materials and methods Patient population Patients with pancreatic adenocarcinoma at Washington University in St.