Comparisons of outcomes of patients with advanced pancreatic cancer (APC) treated with FOLFIRINOX (FX) versus gemcitabine and nab-paclitaxel (GN): A population-based cohort study

Papneja, Neha; Olson, Craig; Chalchal, Haji; Möser, Michael; Iqbal, Nayyar; Haider, Kamal; Zaidi, Adnan; Shaw, James E.; Brunet, Bryan; Dueck, Dorie-Anna; Abbas, Tarek; Ahmed, Salwa M.

doi:10.1093/annonc/mdx369.130a

Cited by 2 publications

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“…In nine studies that reported data separately for the two regimens, 9–76% of patients treated with nab-P/G as first-line therapy received second-line therapy versus 9–94% of those treated with FOLFIRINOX as first-line therapy. 11,17,19,26,29,39,40,42,46 Overall, one study reported that 44% of patients received second-line chemotherapy. 33 Only two of these studies reported OS data in patients receiving second-line therapy.…”

Section: Resultsmentioning

confidence: 99%

Real-world comparative effectiveness of nab-paclitaxel plus gemcitabine versus FOLFIRINOX in advanced pancreatic cancer: a systematic review

et al. 2019

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Background: No clinical trial has directly compared nab-paclitaxel/gemcitabine (nab-P/G) with FOLFIRINOX (fluorouracil/leucovorin/oxaliplatin/irinotecan) in metastatic or advanced pancreatic cancer (mPC or aPC). We conducted a systematic review of real-world studies comparing these regimens in the first-line setting. Methods: Embase and MEDLINE databases through 22 January 2019, and Gastrointestinal Cancers Symposium 2019 abstracts were searched for real-world, retrospective studies comparing first-line nab-P/G versus FOLFIRINOX in mPC or aPC that met specific parameters. Studies with radiotherapy were excluded. Study quality was assessed using the Newcastle–Ottawa Scale. Results: Of 818 records initially identified, 35 were duplicates and 749 did not meet the eligibility criteria, mostly because they were either not comparative ( n = 356) or not first line ( n = 245). The remaining 34 studies (21 mPC; 13 aPC) assessed >6915 patients who received nab-P/G or FOLFIRINOX. In the studies identified, the median overall survival (OS) reached 14.4 and 15.9 months with nab-P/G and FOLFIRINOX, respectively, and median progression-free survival reached 8.5 and 11.7 months, respectively. Safety data were reported in 14 studies (2205 patients), including 8 single-institutional studies. In most single-institutional studies that reported safety data, rates were higher with FOLFIRINOX versus nab-P/G for grade 3/4 neutropenia (five of six studies) and febrile neutropenia (all three studies), while rates of grade 3/4 peripheral neuropathy were higher with nab-P/G in four of seven studies. Conclusions: Although FOLFIRINOX was associated with slightly longer median OS in more studies, the differences, when available, were not statistically significant. Therefore, a randomized, controlled trial is warranted. Toxicity profile differences represent key considerations for treatment decisions.

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Section: Resultsmentioning

confidence: 99%

Real-world comparative effectiveness of nab-paclitaxel plus gemcitabine versus FOLFIRINOX in advanced pancreatic cancer: a systematic review

et al. 2019

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“…In our study, OS was defined as time from start of systemic treatment to death or the date of last follow-up, whereas OS in most other studies is defined as time from diagnosis to death. 22,24,25 The median time between diagnosis and start treatment in our study was 27 days (supplemental eTable 4). This could be specifically important to patients with pancreatic head tumors, because patients with non-pancreatic head tumors tend to start chemotherapy sooner after diagnosis.…”

Section: Discussionmentioning

confidence: 98%

“…Other real-world studies found OS of 14.1 and 9.0 months for FOLFIRINOX, 10.5 and 6.6 months for gemcitabine 1 nab-paclitaxel, and 4.2 months for gemcitabine monotherapy. [22][23][24][25] This survival difference might be partly explained by differences in definition of OS. In our study, OS was defined as time from start of systemic treatment to death or the date of last follow-up, whereas OS in most other studies is defined as time from diagnosis to death.…”

Section: Discussionmentioning

confidence: 99%

“…26 Another explanation might be that in our study the median age at diagnosis was higher compared with other population-based studies, and that these studies included patients with locally advanced disease, who are known to have a better prognosis. [22][23][24][25] As first-line treatment, most patients received FOL-FIRINOX, which was also the dominant regimen in nearly all Dutch hospitals. 15 Compared with other realworld studies, our study shows a higher rate of first-line treatment with FOLFIRINOX.…”

Section: Discussionmentioning

confidence: 99%

“…15 Compared with other realworld studies, our study shows a higher rate of first-line treatment with FOLFIRINOX. [22][23][24] Although OS has significantly improved compared with gemcitabine monotherapy, in current practice FOLFIRINOX is often reserved for patients with a PS of 0 or 1, because of the FOLFIRINOXassociated incidence of grade 3/4 toxicities (eg, neutropenia, thrombocytopenia, fatigue, vomiting). 13,27,28 Because the OS of patients receiving FOLFIRINOX in our study was higher among both those with PS 0-1 and those with PS 2 compared with those receiving gemcitabine 1 nabpaclitaxel (7.4 and 5.1 months vs 4.7 months, respectively; P5.043), one could question whether FOLFIRINOX should be administered only to patients with the most favorable PS, when our study showed that patients with less optimal PS also benefited from FOLFIRINOX treatment in terms of OS.…”

Section: Discussionmentioning

confidence: 99%

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First- and Second-Line Palliative Systemic Treatment Outcomes in a Real-World Metastatic Pancreatic Cancer Cohort

Pijnappel

Dijksterhuis

Geest

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: Metastatic pancreatic ductal adenocarcinoma (PDAC) is characterized by a poor survival rate, which can be improved by systemic treatment. Consensus on the most optimal first- and second-line palliative systemic treatment is lacking. The aim of this study was to describe the use of first- and second-line systemic treatment, overall survival (OS), and time to failure (TTF) of first- and second-line treatment in metastatic PDAC in a real-world setting. Patients and Methods: Patients with synchronous metastatic PDAC diagnosed between 2015 and 2018 who received systemic treatment were selected from the nationwide Netherlands Cancer Registry. OS and TTF were evaluated using Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard analyses. Results: The majority of 1,586 included patients received FOLFIRINOX (65%), followed by gemcitabine (18%), and gemcitabine + nab-paclitaxel (13%) in the first line. Median OS for first-line FOLFIRINOX, gemcitabine + nab-paclitaxel, and gemcitabine monotherapy was 6.6, 4.7, and 2.9 months, respectively. Compared to FOLFIRINOX, gemcitabine + nab-paclitaxel showed significantly inferior OS after adjustment for confounders (hazard ratio [HR], 1.20; 95% CI, 1.02–1.41), and gemcitabine monotherapy was independently associated with a shorter OS and TTF (HR, 1.98; 95% CI, 1.71–2.30 and HR, 2.31; 95% CI, 1.88–2.83, respectively). Of the 121 patients who received second-line systemic treatment, 33% received gemcitabine + nab-paclitaxel, followed by gemcitabine (31%) and FOLFIRINOX (10%). Conclusions: Based on population-based data in patients with metastatic PDAC, treatment predominantly consists of FOLFIRINOX in the first line and gemcitabine with or without nab-paclitaxel in the second line. FOLFIRINOX in the first line shows superior OS compared with gemcitabine with or without nab-paclitaxel.

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Comparisons of outcomes of patients with advanced pancreatic cancer (APC) treated with FOLFIRINOX (FX) versus gemcitabine and nab-paclitaxel (GN): A population-based cohort study

Cited by 2 publications

References 0 publications

Real-world comparative effectiveness of nab-paclitaxel plus gemcitabine versus FOLFIRINOX in advanced pancreatic cancer: a systematic review

Real-world comparative effectiveness of nab-paclitaxel plus gemcitabine versus FOLFIRINOX in advanced pancreatic cancer: a systematic review

First- and Second-Line Palliative Systemic Treatment Outcomes in a Real-World Metastatic Pancreatic Cancer Cohort

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