Evidence map›Paper›PMID 42584721›Full record

ArticleJournal of gastrointestinal cancer2026

Third-Line Treatment Timing After Second-Line Discontinuation in Advanced Pancreatic Cancer: A 30-Day Landmark Analysis.

Kohei Nagata, Shinya Kajiura, Miho Sakumura, Yurika Nakayama, Yuko Ueda, Iori Motoo, Takayuki Ando, Banri Ogino, Hiroki Kawanaka, Jun Sakamoto and 3 more

Abstract read
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Article in Journal of gastrointestinal cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

13 authors.

Kohei NagataThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Shinya KajiuraThird Department of Internal Medicine, University of Toyama, Toyama, Japan. shin-ya@nsknet.or.jp.ORCID http://orcid.org/0000-0003-4920-5130
Miho SakumuraThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Yurika NakayamaThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Yuko UedaThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Iori MotooThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Takayuki AndoThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Banri OginoThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Hiroki KawanakaThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Jun SakamotoThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Toshiki EntaniThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Nobuhiko HayashiThird Department of Internal Medicine, University of Toyama, Toyama, Japan.
Ichiro YasudaThird Department of Internal Medicine, University of Toyama, Toyama, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeEvidence for third-line systemic therapy in advanced pancreatic cancer is limited, and observational comparisons risk time-related and selection biases. We evaluated third-line initiation after second-line discontinuation using a 30-day landmark strategy, focusing on treatment timing and patient selection.

methodsThis single-center retrospective cohort included patients with advanced pancreatic cancer discontinuing second-line systemic therapy between October 2014 and October 2025. The primary analysis included ECOG performance status (ECOG PS) 0-1 patients alive and under observation at day 30. Exposure was initiation within 30 days versus no initiation by day 30, with overall survival (OS) measured from the landmark. Complementary analyses included a 45-day landmark, overlap weighting, time-dependent Cox models, and 60-day mortality after initiation.

resultsAmong 130 patients, 53 received third-line therapy. The primary 30-day landmark cohort included 48 patients. Early initiation showed a directionally favorable but imprecise association with OS (aHR 0.40, 95% CI 0.15-1.04). Findings were similar at the 45-day landmark (aHR 0.33, 95% CI 0.11-1.02) and attenuated with overlap weighting (aHR 0.68, 95% CI 0.38-1.20). Death within 60 days after initiation occurred in 18.9% of recipients and was associated with ECOG PS ≥ 2.

conclusionAmong selected patients with preserved ECOG PS alive and observed at day 30, early third-line initiation showed directionally favorable but imprecise OS. This contrast should be interpreted as early versus deferred-or-no initiation within a 30-day decision window, supporting time-bound patient selection and supportive care-integrated decision-making, not definitive causal inference.

Indexed as

Antineoplastic Combined Chemotherapy ProtocolsPancreatic NeoplasmsAgedFemaleHumansMaleMiddle AgedRetrospective StudiesTime FactorsTreatment InterruptionLandmark analysisPancreatic neoplasmsPerformance statusReal-world evidenceThird-line therapyTreatment timing

Identifiers

PMID42584721

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.