Prognostic Factors of Survival in a Randomized Phase III Trial (MPACT) of Weekly nab-Paclitaxel Plus Gemcitabine Versus Gemcitabine Alone in Patients With Metastatic Pancreatic Cancer

Abstract

Background. nab-Paclitaxel in combination with gemcitabine has emerged as a new treatment option for patients with metastatic pancreatic cancer (MPC), based on superiority over gemcitabine demonstrated in the phase III MPACT trial. Previously, Karnofsky performance status (KPS) score and the presence of liver metastases were shown to be predictive of survival with nab-paclitaxel plus gemcitabine treatment. This analysis sought to further explore the relationship between clinical characteristics and survival in the MPACT trial and to identify potential predictors of overall survival and progression-free survival in patients with MPC. Materials and Methods. Cox regression models adjusted for stratification factors and a stepwise multivariate analysis of prespecified baseline prognostic factors were performed. Results. Treatment effect was significantly associated with survival, with a similar magnitude of reduction in risk of

Dose modification and efficacy of nab-paclitaxel plus gemcitabine vs. gemcitabine for patients with metastatic pancreatic cancer: phase III MPACT trial

“…Both dose reduction (HR, 0.61; P<0.001) and dose delay (HR, 0.77; P=0.007) were significantly associated with longer OS (Table S3). Treatment group, KPS, and presence of liver metastases were also significant predictors, as shown in a prior analysis (29), as was number of metastatic sites. Separate multivariate analyses were performed within each treatment arm to account for the statistical issue of higher rates of dose modifications in the nab-P + Gem arm (Table S3); dose reduction remained significantly associated with longer OS in each treatment Gem, gemcitabine; nab-P, nab-paclitaxel.…”

Survival of patients with pancreatic cancer treated with varied modalities: A single-centre study

“…The present study has suggested that response to therapy, in patients with metastatic disease who are treated with chemotherapy, is potentially a beneficial prognostic factor. Di Marco et al (1) argued that Gem remains a mainstay of treatment for advanced pancreatic cancer, and that the combination of Gem with a variety of cytotoxic and targeted agents has generally revealed no significant survival advantage as compared with Gem alone, aside from the recent metastatic adenocarcinoma of the pancreas (MPACT) study by Tabernero et al (9). The present study examined the OS of patients treated with chemotherapy, and did not compare specific treatment regimes, since, in this study, the majority of patients were treated with Gem alone.…”

“…Gemcitabine (Gem) has been the standard first-line chemotherapy since 1997 (5); however, two novel therapies, irinotecan-5-fluorouracil-leucoverin-oxaliplatin (FOLFIRINOX) and nab-paclitaxel plus Gem, have recently shown markedly improved overall survival (OS) rates in a certain subset of patients (6)(7)(8)(9).…”

Successful Evidence-Based Treatment of Patients with Advanced Pancreatic Cancer in Community-Based Oncology Group Practices

“…More patients with metastatic disease were analyzed in the current study (73.8 vs. 66.1% in the earlier study). Age, ECOG performance status, and metastasis are established risk factors which influence the outcome of patients with pancreatic cancer [13]. The differences in representation of the patient subgroups with respect to these confounding variables are most likely responsible for the differences in outcomes observed between the 2 cohorts.…”