Comparison of FOLFIRINOX vs Gemcitabine Plus Nab-Paclitaxel as First-Line Chemotherapy for Metastatic Pancreatic Ductal Adenocarcinoma

Klein-Brill, Avital; Amar-Farkash, Shlomit; Lawrence, Gabriella; Collisson, Eric A.; Aran, Dvir

doi:10.1001/jamanetworkopen.2022.16199

Cited by 43 publications

(26 citation statements)

References 26 publications

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“…At our institution, FOLFIRINOX is often offered to patients with resectable or borderline resectable pancreatic cancer, whereas gemcitabine-based therapy is often offered to patients with metastatic pancreatic cancer. Recently, the first cross-institutional retrospective study across 388 centers in the USA ( n = 1102) showed that FOLFIRINOX was associated with more than 2 months of survival advantage over gemcitabine with nab-paclitaxel in this subgroup of pancreatic cancer [ 12 ]. A recent meta-analysis showed no significant difference between FOLFIRINOX and gemcitabine with nab-paclitaxel in terms of overall survival and progression-free survival.…”

Section: Discussionmentioning

confidence: 99%

Challenges in managing upper gastrointestinal bleeding secondary to primary squamous cell carcinoma of the pancreas: a case report and literature review

et al. 2023

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Background Primary pancreatic squamous cell carcinoma (SCC) is a rare type of pancreatic cancer, with an incidence of 5% of all pancreatic cancers. This condition is associated with a poor prognosis, and no optimal treatment has been established (Zhang et al. in Medicine (Baltim). 97:e12253, 2018). Case presentation A 56-year-old man presented to our hospital with upper gastrointestinal bleeding and new-onset diabetes mellitus. He had no other medical comorbidities, episodes of pancreatitis and symptoms secondary to pancreatic insufficiency. A computed tomography (CT) scan showed a 94 × 72 × 83 mm necrotic pancreatic body mass with gastric invasion and multiple liver metastases. Gastroscopy revealed deep ulcerations at the posterior wall of the stomach with an active slow ooze. Endoscopic ultrasound was performed with EUS guided biopsy, which confirmed poorly differentiated squamous carcinoma of the pancreas. The patient underwent palliative radiotherapy for recurrent upper gastrointestinal bleeding followed by palliative chemotherapy with gemcitabine and nab-paclitaxel. He was referred to dietitians and diabetes educators for the management of pancreatic exocrine and endocrine insufficiency before being referred to community palliative care upon discharge. Conclusions This is the first reported Australian case of pancreatic SCC presenting with upper gastrointestinal bleeding and new-onset diabetes mellitus. Patients with unresectable disease require a multidisciplinary approach to manage complications and improve symptom control. However, there are no standard treatment guidelines and future research is needed in this regard.

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Section: Discussionmentioning

confidence: 99%

Challenges in managing upper gastrointestinal bleeding secondary to primary squamous cell carcinoma of the pancreas: a case report and literature review

et al. 2023

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“…Although a cross-trial comparison suggested better efficacy but more neutropenia with the FOLFIRINOX regimen, there are no published randomized trials in the metastatic setting directly compared FOLFIRINOX to GEM-NabP. However, a meta-analysis [22] and a multicenter retrospective study [23] comparing first-line FOLFIRINOX and GEM-NabP regimens in metastatic PDAC demonstrated improved survival with FOLFIRINOX. Furthermore, FOLFIRINOX was associated with fewer post-treatment hospitalizations and lower post-treatment costs.…”

Section: Metastatic Pdacmentioning

confidence: 99%

Initial chemotherapy option for pancreatic ductal adenocarcinoma in patients with adequate performance status

Xing,

Ge,

Gong

et al. 2023

Journal of Pancreatology

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Pancreatic ductal adenocarcinoma (PDAC) is a highly progressive lethal malignancy, with chemotherapy being the primary treatment modality. This article provides a review of the initial chemotherapy options for PDAC patients with adequate performance status, comparing FOLFIRINOX (oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin) or modified FOLFIRINOX and gemcitabine plus nab-paclitaxel (GEM-NabP) regimens. The availability of limited evidence from randomized trials restricts a direct comparison between the two regimens. Based on our review, (m)FOLFIRINOX yields superior survival outcomes compared to GEM-NabP in metastatic PDAC. For locally advanced PDAC, either (m)FOLFIRINOX or GEM-NabP can be considered initial chemotherapy. In the neoadjuvant setting for borderline resectable PDAC, both regimens have demonstrated promising results in achieving feasible resection rates. However, mFOLFIRINOX remains the preferred choice for adjuvant chemotherapy. The selection of initial chemotherapy for PDAC depends on the disease stage, patients' performance status, and tumor molecular alterations. Further research and clinical trials are necessary to optimize treatment approaches for PDAC patients.

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“…Other benefits of chemotherapy also include the expansion of the resectable population, reduction of tumor burden, control of occult metastases and prevention of recurrence/metastasis. (Neoadjuvant) FOLFIRINOX was associated with a 4.9-and 2.0-month improvement in survival compared with (neoadjuvant) AG for resectable/borderline resectable pancreatic cancer and metastatic pancreatic ductal adenocarcinoma, respectively [6,7]. These chemotherapeutic drugs exert anticancer effects by damaging DNA and RNA and inhibiting thymidylate synthase.…”

Section: Introductionmentioning

confidence: 99%

Reshaping the Pancreatic Cancer Microenvironment at Different Stages with Chemotherapy

Peng

Ying

Zhang

et al. 2023

Cancers

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The dynamic tumor microenvironment, especially the immune microenvironment, during the natural progression and/or chemotherapy treatment is a critical frontier in understanding the effects of chemotherapy on pancreatic cancer. Non-stratified pancreatic cancer patients always receive chemotherapeutic strategies, including neoadjuvant chemotherapy and adjuvant chemotherapy, predominantly according to their physical conditions and different disease stages. An increasing number of studies demonstrate that the pancreatic cancer tumor microenvironment could be reshaped by chemotherapy, an outcome caused by immunogenic cell death, selection and/or education of preponderant tumor clones, adaptive gene mutations, and induction of cytokines/chemokines. These outcomes could in turn impact the efficacy of chemotherapy, making it range from synergetic to resistant and even tumor-promoting. Under chemotherapeutic impact, the metastatic micro-structures in the primary tumor may be built to leak tumor cells into the lymph or blood vasculature, and micro-metastatic/recurrent niches rich in immunosuppressive cells may be recruited by cytokines and chemokines, which provide housing conditions for these circling tumor cells. An in-depth understanding of how chemotherapy reshapes the tumor microenvironment may lead to new therapeutic strategies to block its adverse tumor-promoting effects and prolong survival. In this review, reshaped pancreatic cancer tumor microenvironments due to chemotherapy were reflected mainly in immune cells, pancreatic cancer cells, and cancer-associated fibroblast cells, quantitatively, functionally, and spatially. Additionally, small molecule kinases and immune checkpoints participating in this remodeling process caused by chemotherapy are suggested to be blocked reasonably to synergize with chemotherapy.

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Comparison of FOLFIRINOX vs Gemcitabine Plus Nab-Paclitaxel as First-Line Chemotherapy for Metastatic Pancreatic Ductal Adenocarcinoma

Cited by 43 publications

References 26 publications

Challenges in managing upper gastrointestinal bleeding secondary to primary squamous cell carcinoma of the pancreas: a case report and literature review

Challenges in managing upper gastrointestinal bleeding secondary to primary squamous cell carcinoma of the pancreas: a case report and literature review

Initial chemotherapy option for pancreatic ductal adenocarcinoma in patients with adequate performance status

Reshaping the Pancreatic Cancer Microenvironment at Different Stages with Chemotherapy

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