Gemcitabine/nab-paclitaxel as second-line therapy following FOLFIRINOX in metastatic/advanced pancreatic cancer—retrospective analysis of response

Nguyen, Khanh; Kalyan, Aparna; Beasley, H. Scott; Singhi, Aatur D.; Sun, Weijing; Zeh, Herbert J.; Normolle, Daniel P.; Bahary, Nathan

doi:10.21037/jgo.2017.01.23

Cited by 33 publications

(38 citation statements)

References 25 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Asano

Hirano

Nakamura

et al. 2018

J Hepato Biliary Pancreat

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Section: Discussionmentioning

confidence: 99%

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

Asano

Hirano

Nakamura

et al. 2018

J Hepato Biliary Pancreat

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“…When the combination of irinotecan, oxaliplatin, leucovorin and 5FU (FOLFIRINOX) regimen is given as a first line therapy, patient in good shape could be treated with a gemcitabine-based regimen. Reports have shown feasibility of this regimen [46,47], but there are no phase III trials supporting this recommendation. As a result, from first line chemotherapy toxicity and declined performance status, it is advisable to use an attenuated regimen in this situation, reducing doses or changing schedules to biweekly administration [48].…”

Section: Second-line Systemic Therapy For Metastatic or Local Advancementioning

confidence: 99%

Current Systemic Treatment Options for Metastatic and Unresectable Pancreatic Cancer

Caglevic¹,

Mahave²,

Sanhueza³

et al. 2021

Challenges in Pancreatic Cancer

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Metastatic and local advanced unresectable pancreatic cancers are lethal conditions that always carry a poor prognosis with rare exceptions. Currently, the mainstay of therapy is cytotoxic chemotherapy plus best supportive care. First-line therapy for patients with a good performance status includes FOLFIRINOX or gemcitabine plus nab-paclitaxel regimens. Patients carrying a deleterious germline BRCA mutation can be treated with maintenance olaparib after FOLFIRINOX. Patients with a poor performance status, but still fit enough for chemotherapy, may be treated with single agent gemcitabine. Second-line therapy will depend on previous therapy and current performance status. Options for patients treated with gemcitabine-based regimens are 5-fluorouracil plus leucovorin plus either nanoliposomal irinotecan, irinotecan or oxaliplatin. Patients that were treated with first line FOLFIRINOX may benefit from a gemcitabine-based chemotherapy, but evidence from randomized trials is lacking. Other options like immunotherapy and targeted therapies yield benefit only in very selected cases, and it is still an area of research.

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“…Although there is no data from randomized, controlled studies to support this strategy, multiple single-institution, retrospective analyses suggest that gemcitabine/nab-paclitaxel is a reasonable second-line option following FOLFIRINOX. 22,23,24 …”

Section: Second-line Systemic Treatment For Advanced Pancreatic Cancermentioning

confidence: 99%

Current Standards of Chemotherapy for Pancreatic Cancer

Saung

2017

Clinical Therapeutics

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Purpose Pancreatic cancer has a dismal prognosis due to the early development of systemic metastatic disease. Chemotherapeutics are the only systemic therapies that offer a meaningful benefit to the patients. Methods We reviewed the literature for recently published phase III clinical trials whose results have guided the current standards of chemotherapy for pancreatic cancer. Findings Although combination chemotherapy regimens are shown to be superior to gemcitabine monotherapy for both metastatic pancreatic cancer and adjuvant chemotherapy following surgical resection, it should be recognized that all the combination chemotherapy regimens only offer limited benefits. In addition, there is a paucity of clinical trials that directly compare the various combination chemotherapy regimens. Implications With the advancement of systemic cancer treatment beyond chemotherapy, it is important to devote more investigation into better understanding the biology of these chemotherapy regimens, such that we combine them with targeted therapeutics and immunotherapeutics in a rational and scientific manner. For the current treatment of pancreatic cancer, the available chemotherapy regimens have shown modest but statistically significant improvements in survival. However, it is important to avoid cross-comparisons of trials and choose regimens based on patient characteristics and side effect profiles of the regimen.

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Gemcitabine/nab-paclitaxel as second-line therapy following FOLFIRINOX in metastatic/advanced pancreatic cancer—retrospective analysis of response

Abstract: This study demonstrates a clinical benefit of second-line nPG. The study also suggests a possible use of CA19-9 to predict response to therapy.

Cited by 33 publications

References 25 publications

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

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

Current Systemic Treatment Options for Metastatic and Unresectable Pancreatic Cancer

Current Standards of Chemotherapy for Pancreatic Cancer

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