Comparison of efficacy and toxicity of FOLFIRINOX and gemcitabine with nab-paclitaxel in unresectable pancreatic cancer

Abstract

Background: Irinotecan, oxaliplatin and leucovorin-modulated fluorouracil (FOLFIRINOX) and the combination regimen of gemcitabine and nanoparticle albumin-bound paclitaxel (GnP) (nab-PTX) improve the prognosis of patients with metastatic pancreatic cancer. However, no study has compared the efficacy of the two regimens. We compared retrospectively the efficacy and safety of the two regimens in patients with unresectable pancreatic cancer. Methods: Thirty-eight patients with unresectable locally advanced or metastatic pancreatic cancer received FOLFIRINOX or GnP as first-line chemotherapy between December 2013 and September 2015.In the FOLFIRINOX group, patients received 85 mg/m 2 oxaliplatin followed by 180 mg/m 2 irinotecan and 200 mg/m 2 L-leucovorin, and by 400 mg/m 2 fluorouracil as a bolus and 2,400 mg/m 2 fluorouracil as a 46-h continuous infusion every 14 days. In the GnP group, patients received 125 mg/m 2 nab-PTX followed by 1 g/m 2 , and gemcitabine on days 1, 8 and 15, repeated every 28 days. Results: Response rate was 6.3% in the FOLFIRINOX group and 40.9% in the GnP group (P=0.025).Median progression-free survival (PFS) was 3.7 months [95% confidence interval (CI), 3.0-4.5] in the FOLFIRINOX group and 6.5 months (95% CI, 6.2-6.9 months) in the GnP group (P=0.031). Drug toxicity in the GnP group was less than in the FOLFIRINOX group. Conclusions: Efficacy and safety of GnP compare favorably to those of FOLFIRINOX in patients with pancreatic cancer. Additional prospective trials are warranted.

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

“…Gemcitabine-based combination regimens, with either S-1 or nab-paclitaxel, have been associated with more frequent chemotherapy-related AEs [ 15 , 16 ]. Previous clinical trials support the conclusion that FOLFIRINOX is more toxic than gemcitabine and nab-paclitaxel [ 17 ]. In Asia, most patients with APC cannot tolerate the AEs associated with FOLFIRINOX; therefore, its application is limited.…”

Survival benefit of conversion surgery for patients with initially unresectable pancreatic cancer who responded favorably to nonsurgical treatment

“…In this manner, while the therapeutic effect of CS on patients with UR-PC is investigated, progress of chemo(radio)therapy is remarkable, and FOLFIRINOX or GnP regimen is used as first-line chemotherapy for patients with UR-PC. 12,13,[24][25][26] Hackert et al 13 reported that patients with UR-PC who received FOLFIRINOX as NST had a higher conversion rate and a better prognosis than those received other regimen and they advocated that FOLFIRINOX should be first-line therapy for patients with UR-PC. As the antitumor effect of these regimens are very high, candidates for CS are expected to increase.…”

Irreversible JNK1-JUN inhibition by JNK-IN-8 sensitizes pancreatic cancer to 5-FU/FOLFOX chemotherapy

“…FOLFOX itself is also a promising candidate for further drug combination, as it has been combined with the chemotherapy irinotecan to form FOLFIRINOX, the first-line treatment for both adjuvant chemotherapy and metastatic PDAC (9,10). This combination's greatly increased efficacy was a breakthrough in PDAC, but the addition of the cytotoxic irinotecan leads to increased frequency and severity of side effects (9)(10)(11). Therefore, at many centers, it is currently only recommended to healthier, younger patients, which may exclude as many as 75% of metastatic PDAC patients (12).…”