Comparison of Treatment Outcomes Between Gemcitabine With Nab-Paclitaxel and Modified FOLFIRINOX for First-Line Chemotherapy in Metastatic and Recurrent Pancreatic Cancer

Abstract

Objectives: To compare the treatment outcomes of gemcitabine with nab-paclitaxel (GnP) and modified FOLFIRINOX (mFFX; a combination of fluorouracil, leucovorin, irinotecan, and oxaliplatin) for metastatic pancreatic cancer. Methods:We retrospectively analyzed consecutive patients with metastatic or recurrent pancreatic cancer treated with GnP or mFFX as the first-line chemotherapy between March 2014 and December 2019 in our hospital. Treatment outcomes were compared using propensity score matching to adjust for age, sex, performance status, carcinoembryonic antigen levels, carbohydrate antigen 19-9 levels, and disease status (metastatic or recurrent).Results: Five hundred sixty-eight patients were included (GnP/mFFX, 456/112). After propensity score matching, 218 patients were extracted. The median age was around 61 years, and the proportion of performance status 0 was approximately 90%. The median overall survival values were 14.6 and 15.5 months (P = 0.45), and the median progression-free survival was 7.4 months (P = 0.53) for GnP and mFFX, respectively. The disease control rates were higher in the GnP group (82.6% vs 67.9%, P = 0.02). In nonhematologic adverse events, grade 3/4 anorexia and diarrhea occurred significantly more frequently in the mFFX group.Conclusions: Gemcitabine with nab-paclitaxel had a higher disease control rate and lower rates of severe anorexia and diarrhea in our propensity-matched population.

Endoscopic Ultrasound-guided Radiofrequency Ablation for Pancreatic Adenocarcinoma

“…Chemotherapy in combination with surgery for PDAC is tolerated; however, both modi ed FOLFIRNOX and Gem/nab-P have noted toxicities and adverse events [13]. In this report, patients tolerated 4 months of NAC plus EUS-RFA.…”

Treatment Outcomes and Prognostic Factors of Gemcitabine Plus Nab-Paclitaxel as Second-Line Chemotherapy after Modified FOLFIRINOX in Unresectable Pancreatic Cancer

“…Both mFFX and GnP are known to cause peripheral neuropathy. The frequency of grade 3/4 peripheral neuropathy of first-line mFFX and GnP was reported to be 1.8-9.0% and 2.8-17.0%, respectively [2,3,5]. The frequency of grade 3/4 peripheral neuropathy of second-line mFFX after GnP was reported to be 1.2-5.1% [8,33].…”

“…The outcomes of this study were comparable to previous reports. On the other hand, median PFS of GnP as first-line treatment has been reported to be 5.0-8.4 months [3,5,[25][26][27]. Outcomes of second-line GnP may be worse than those of first-line GnP because of poor general condition, high tumor volume, and resistance to chemotherapy.…”

“…Treatment outcomes of chemotherapy for unresectable PC have improved with the advent of FOLFIRINOX (FFX) and gemcitabine plus nab-paclitaxel (GnP) [2][3][4]. As superiority of one regimen over the other is still controversial, both FFX and GnP are positioned as standard first-line therapy [5].…”

Neoadjuvant therapy for resectable pancreatic cancer: a narrative review

“…Hackert et al considered FOLFIRINOX to be the most effective protocol compared with other regimens. [36] Mie et al [50] compared gemcitabine plus nab-paclitaxel with modified FOLFIRINOX in patients with metastatic and recurrent pancreatic cancer and found that gemcitabine plus nab-paclitaxel had a higher disease control rate and lower rates of severe anorexia and diarrhea. In a NAT study for resectable and borderline resectable patients, the OS and lymph node metastases of the FOLFIRINOX group were better than those of the gemcitabine plus nab-paclitaxel group.…”