A Chinese Retrospective Multicenter Study of First-Line Chemotherapy for Advanced Pancreatic Cancer

Abstract

Background Pancreatic cancer (PC) is a common digestive system tumor. For patients with advanced pancreatic cancer (APC), chemotherapy is still the predominant treatment. However, no large-scale clinical studies have been done of it as first-line therapy for APC. The goal of the present study was to assess real-world outcomes with chemotherapy in that setting. Material/Methods We retrospectively analyzed data from 322 patients with APC who were treated with chemotherapy at 4 hospitals in different cities in China. The first-line regimens used were AS (nab-paclitaxel and S-1), AG (nab-paclitaxel and gemcitabine), and FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin). Results Of the patients, 232 received AS, 79 received AG, and 11 received FOLFIRINOX. The median number of chemotherapy cycles was 5. The median overall survival (mOS) was 9 months and the median progression-free survival (mPFS) was 5 months. The AS, AG, and FOLFIRINOX regimens were associated with mOS rates of 9 months, 9 months, and 10 months, respectively. The mPFS rates for the AS, AG, and FOLFIRINOX regimens were 5, 4, and 5 months, respectively. The differences between the PFS rates for the regimens were statistically significant. The overall response rate (ORR) and overall disease control rate (DCR) for chemotherapy were 38% and 81.8%, respectively. The ORRs for the AS, AG, and FOLFIRINOX regimens were 46.9%, 18.7%, and 0%, respectively. The DCRs for the AS, AG and FOLFIRINOX regimens were 87.2%, 69.3%, and 63.6%, respectively. The differences between the ORRs and DCRs for the regimens were statistically significant. The incidences of grade 3/4 adverse events (AEs) associated with the AS, AG, and FOLFIRINOX regimens were 29.9%, 25%, and 36.4%, respectively. Conclusions The AS regimen was associated with a higher ORR and DCR than the other 2 regimens, with a lower rate of AEs.

A Modified Regimen of 21-day Nab-Paclitaxel Plus Gemcitabine in Locally Advanced or Metastatic Pancreatic Cancer: A Retrospective Real-World Study

“…At this stage, we can only speculate that this controversial result may relate with the inherent risk of confounding and selection bias. The efficacy of 21-day nab-P/Gem chemotherapy was consistent with published retrospective studies, 15 , 16 and the OS of this modified regimen seemed to be comparable with the OS of the traditional 28-day regimen reported by recent real-world studies listed in Table 3 . 17 , 18 …”

Nomogram to predict survival of patients with advanced and metastatic pancreatic Cancer

“…The results showed that the median overall survival of gemcitabine-based combination chemotherapy and nab-paclitaxel plus S1 was better than gemcitabine monotherapy with statistic significant (TableS 5 and Fig 1S A-F Supplement). Our team retrospectively analyzed multicenter first-line chemotherapy regimens of advanced pancreatic cancer, the results showed that nab-paclitaxel plus S1 was not inferior to nab-paclitaxel plus gemcitabine or FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) [ 28 ]. However, the final model did not incorporate chemotherapy regimens or laboratory markers levels at 6 weeks, unless these changes were shown statistically significant by multivariate analysis.…”

Survival outcome of different treatment sequences in patients with locally advanced and metastatic pancreatic cancer

“…In our center, we treated approximately seventy of our patients between 2015 and 2021 with rst-line Nab-Paclitaxel plus S-1, and only a very small proportion with FOLFIRINOX. The e cacy and safety of nab-paclitaxel plus S-1 as the rst-line treatment in patients with locally advanced and metastatic PDA have been demonstrated in previous study of our center and given these preclinical and preliminary clinical data, the combination of nabpaclitaxel and S-1 could theoretically be an option for pancreatic cancer [16,17].…”