Nab-paclitaxel plus gemcitabine versus FOLFIRINOX as the first-line chemotherapy for patients with metastatic pancreatic cancer: retrospective analysis

Kang, JiHoon; Hwang, Ilseon; Yoo, Changhoon; Kim, Kyu-Pyo; Jeong, Jae Ho; Chang, Heung-Moon; Lee, Sang Soo; Park, Do Hyun; Song, Tae Jun; Seo, Dong Wan; Lee, Sung Koo; Kim, Myung–Hwan; Hong, Seung‐Mo; Shin, Sang Hyun; Hwang, Dae Wook; Song, Ki Byung; Lee, Jae Hoon; Kim, Song Cheol; Ryoo, Baek‐Yeol

doi:10.1007/s10637-018-0598-5

Cited by 101 publications

(96 citation statements)

References 22 publications

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“…Although patients in the nab-paclitaxel plus gemcitabine cohort were older and had worse PS than patients who received FOLFIRINOX, median TTF and median OS were not statistically different between these groups. These findings are consistent with other recent real-world studies, reporting comparable progression-free survival and OS with either nab-paclitaxel plus gemcitabine or FOLFIRINOX as 1L therapy, but improved efficacy in comparison to gemcitabine monotherapy [12, 13]. The real-world study by Kang et al reported comparable progression-free survival (6.8 vs. 5.1 months) and OS (11.4 vs. 9.6 months) in patients receiving nab-paclitaxel plus gemcitabine or FOLFIRINOX as 1L therapy, respectively [12].…”

Section: Discussionsupporting

confidence: 92%

Clinical Outcomes with First-Line Chemotherapy in a Large Retrospective Study of Patients with Metastatic Pancreatic Cancer Treated in a US Community Oncology Setting

Cartwright¹,

Parisi²,

Espirito

et al. 2018

Drugs - Real World Outcomes

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BackgroundThe combination chemotherapy regimens of nab-paclitaxel plus gemcitabine (nab-p + G) and FOLFIRINOX (FFX) have each demonstrated improved survival compared with gemcitabine monotherapy in clinical trials for metastatic pancreatic cancer; however, limited comparative data exist.ObjectiveThe objective of this study was to compare patient characteristics and clinical outcomes including time to treatment failure and overall survival in patients with metastatic pancreatic cancer receiving first-line chemotherapy in the community.MethodsWe conducted a retrospective, multi-site, observational cohort study of patients with metastatic pancreatic cancer receiving first-line nab-p + G, FFX, or gemcitabine monotherapy between April 2013 and October 2015, using data from the iKnowMed electronic health record database. Patients on clinical trials or with other cancer diagnoses were excluded. Time to treatment failure and overall survival were assessed by Kaplan–Meier methods.ResultsFour hundred and eighty-six patients met selection criteria, 255 nab-p + G, 159 FFX, and 72 gemcitabine patients. Median age was 61, 68, and 73 years for FFX, nab-p + G, and gemcitabine patients, respectively (p < 0.01 for nab-p + G vs. FFX). Eastern Cooperative Oncology Group performance status of 0–1 was 91% for FFX, 77% for nab-p + G, and 68% for gemcitabine patients (p < 0.01 for nab-p + G vs. FFX). For the nab-p + G vs. FFX cohorts, respectively, time to treatment failure was 3.7 vs. 4.3 months (log-rank p = 0.25); and OS was 9.8 vs. 11.4 months (log-rank p = 0.38). Among patients with Eastern Cooperative Oncology Group performance status 0–1, time to treatment failure was 4.2 vs. 4.3 months (log-rank p = 0.47); and overall survival was 12.1 vs 11.4 months (log-rank p = 0.68).ConclusionsThe nab-p + G patients were older and had worse performance status than FFX patients. Time to treatment failure and overall survival were not observed to be significantly different in first-line nab-p + G and FFX patients. Results were similar after stratifying by performance status.

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Section: Discussionsupporting

confidence: 92%

Clinical Outcomes with First-Line Chemotherapy in a Large Retrospective Study of Patients with Metastatic Pancreatic Cancer Treated in a US Community Oncology Setting

Cartwright¹,

Parisi²,

Espirito

et al. 2018

Drugs - Real World Outcomes

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“…Even for patients with localized and resectable tumours, the 5-year OS rate is only approximately 27% [7]. Chemotherapy based on gemcitabine (Gem) is currently the standard treatment for metastatic PDAC, and the combination of Gem with oxaliplatin, irinotecan, leucovorin and 5-fluorouracil (FOLFIRINOX) can reduce the mortality rate but has been shown to increase toxicity and to have a poor survival benefit and high cost burden [8,9]. Therefore, the exploration of new therapies for PDAC is urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Current advances and outlooks in immunotherapy for pancreatic ductal adenocarcinoma

et al. 2020

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Pancreatic ductal adenocarcinoma (PDAC) is an incurable cancer resistant to traditional treatments, although a limited number of early-stage patients can undergo radical resection. Immunotherapies for the treatment of haematological malignancies as well as solid tumours have been substantially improved over the past decades, and impressive results have been obtained in recent preclinical and clinical trials. However, PDAC is likely the exception because of its unique tumour microenvironment (TME). In this review, we summarize the characteristics of the PDAC TME and focus on the network of various tumour-infiltrating immune cells, outlining the current advances in PDAC immunotherapy and addressing the effect of the PDAC TME on immunotherapy. This review further explores the combinations of different therapies used to enhance antitumour efficacy or reverse immunodeficiencies and describes optimizable immunotherapeutic strategies for PDAC. The concordant combination of various treatments, such as targeting cancer cells and the stroma, reversing suppressive immune reactions and enhancing antitumour reactivity, may be the most promising approach for the treatment of PDAC. Traditional treatments, especially chemotherapy, may also be optimized for individual patients to remodel the immunosuppressive microenvironment for enhanced therapy.

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“…This preferred adjuvant regimen might trouble clinicians in current clinical practice due to the lack of objective parameters from prospective randomized studies comparing the different therapeutic options. Results from retrospective comparisons between mFOLFIRINOX and gem-nab/p strategies are available only in advanced settings, and suggest no difference in efficacy [16]. In order to provide solid evidence, we analyzed and compared the efficacy and safety of adjuvant options for resected PC (gem-cap, mFOLFIRINOX, and gem-nab/P) through a systematic review of data reported in the international literature.…”

Section: Introductionmentioning

confidence: 99%

Moving the Target on the Optimal Adjuvant Strategy for Resected Pancreatic Cancers: A Systematic Review with Meta-Analysis

Galvano

Castiglia

Rizzo

et al. 2020

Cancers

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Combination regimens have shown superiority over single agents in the adjuvant treatment of resected pancreatic cancer (PC), but there are no data supporting definition of the best regimen. This work aimed to compare the efficacy and safety of mFOLFIRINOX, gemcitabine+capecitabine, and gemcitabine+nab/paclitaxel in PC patients. A meta-analysis was performed for direct comparison between trials comparing combination regimens and gemcitabine monotherapy. Subsequently, an indirect comparison was made between trials investigating the efficacy and safety of mFOLFIRINOX, gemcitabine+capecitabine, and gemcitabine+nab/paclitaxel because of the same control arm (gemcitabine). A total of three studies met the selection criteria and were included in our indirect comparison. Indirect comparisons for efficacy outcomes showed a benefit in terms of DFS (disease-free survival)/EFS (event-free survival)/RFS (relapse-free survival) for both mFOLFIRINOX versus gemcitabine+capecitabine (HR 0.69, 95% CI 0.52–0.91) and versus gemcitabine+nab/paclitaxel (HR 0.67, 95% CI 0.50–0.90). No significant advantage was registered for OS (overall survival). Indirect comparisons for safety showed an increase in terms of G3-5 AEs (with the exception of neutropenia) for mFOLFIRINOX versus gemcitabine+capecitabine (RR 1.24, 95% CI 1.03–1.50), while no significant differences were observed versus gemcitabine+nab/paclitaxel. According to our results, mFOLFIRINOX is feasible and manageable and could represent a first option for fit PC resected patients.

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Nab-paclitaxel plus gemcitabine versus FOLFIRINOX as the first-line chemotherapy for patients with metastatic pancreatic cancer: retrospective analysis

Cited by 101 publications

References 22 publications

Clinical Outcomes with First-Line Chemotherapy in a Large Retrospective Study of Patients with Metastatic Pancreatic Cancer Treated in a US Community Oncology Setting

Clinical Outcomes with First-Line Chemotherapy in a Large Retrospective Study of Patients with Metastatic Pancreatic Cancer Treated in a US Community Oncology Setting

Current advances and outlooks in immunotherapy for pancreatic ductal adenocarcinoma

Moving the Target on the Optimal Adjuvant Strategy for Resected Pancreatic Cancers: A Systematic Review with Meta-Analysis

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