<em>nab</em>-Paclitaxel plus gemcitabine for metastatic pancreatic cancer: a subgroup analysis of the Western European cohort of the MPACT trial

Abstract

PurposeThe global Phase III MPACT trial demonstrated superior efficacy of nab-paclitaxel plus gemcitabine over gemcitabine alone as first-line treatment for metastatic pancreatic cancer. Region was a randomization stratification factor in the MPACT trial. This subgroup analysis of MPACT examined efficacy and safety of patients treated in Western Europe.Patients and methodsPatients received nab-paclitaxel plus gemcitabine or gemcitabine alone as first-line treatment for metastatic pancreatic cancer as previously described. A total of 76 patients were included in this analysis (n=38 for each arm).ResultsDifferences between the overall Western European cohort and the intention-to-treat population included lower percentages of male patients (46% and 58%, respectively) and patients with biliary stents (8% and 17%), and higher percentages of patients with Karnofsky performance status of 90–100 (78% and 60%) and primary tumors in the body of the pancreas (48% and 31%). The median overall survival was 10.7 months with nab-paclitaxel plus gemcitabine vs 6.9 months with gemcitabine alone (hazard ratio [HR]: 0.82 [95% confidence interval (CI): 0.48–1.40]; P=0.471). Median progression-free survival was 5.3 vs 3.7 months, respectively (HR: 0.70 [95% CI: 0.37–1.33]; P=0.277). The independently assessed overall response rate was 18% vs 5% (response rate ratio, 3.50 [95% CI: 0.78–15.78]; P=0.076). The most common grade ≥3 adverse events with nab-paclitaxel plus gemcitabine and gemcitabine alone were neutropenia (46% vs 33%, respectively), leukopenia (35% vs 19%), anemia (22% vs 0%), asthenia (21% vs 6%), thrombocytopenia (14% vs 3%), and peripheral neuropathy (13% vs 3%).ConclusionAlthough a statistically significant difference between the treatment arms was not reached for efficacy endpoints, this study does report treatment benefit and a manageable safety profile associated with nab-paclitaxel plus gemcitabine in patients treated in Western Europe with metastatic pancreatic cancer.

Results from the prospective German TPK clinical cohort study: Treatment algorithms and survival of 1,174 patients with locally advanced, inoperable, or metastatic pancreatic ductal adenocarcinoma

“…The subgroup analysis of the Western European cohort of the MPACT trial on 38 patients treated with nab-paclitaxel plus gemcitabine reported a median PFS of 5.3 months (TPK: 5.6 months) and a median OS of 10.7 months (TPK: 9.1 months). 22 The Canadian subgroup analysis of the MPACT trial on 33 patients receiving nab-paclitaxel plus gemcitabine reported a median OS of 11.9 months. 23 In both analyses, the patients were considerably younger than the patients within the TPK with a median age of 60-61 vs. 70 years.…”

“…23 In both analyses, the patients were considerably younger than the patients within the TPK with a median age of 60-61 vs. 70 years. 22,23 A retrospective analysis including 41 patients with metastatic pancreatic ductal adenocarcinoma treated with at least 1 cycle of nab-paclitaxel plus gemcitabine in Italy reported a median PFS of 6.7 months and a median OS of 10 months. 24 A single institution retrospective chart review of young and fit patients (n = 50, median age 55, WHO performance status 0/1) with 82% receiving FOLFIRINOX reported a median OS of 14.8 months for patients with locally advanced and 9.0 months for metastatic pancreatic cancer, with dose modifications in 90% of the patients and 52% grade 3-4 toxicity.…”

“…The median OS of the TPK‐cohort was 9.2 months, which certainly reflects the effectiveness of these new treatment options. The subgroup analysis of the Western European cohort of the MPACT trial on 38 patients treated with nab ‐paclitaxel plus gemcitabine reported a median PFS of 5.3 months (TPK: 5.6 months) and a median OS of 10.7 months (TPK: 9.1 months) . The Canadian subgroup analysis of the MPACT trial on 33 patients receiving nab ‐paclitaxel plus gemcitabine reported a median OS of 11.9 months .…”

“…The Canadian subgroup analysis of the MPACT trial on 33 patients receiving nab ‐paclitaxel plus gemcitabine reported a median OS of 11.9 months . In both analyses, the patients were considerably younger than the patients within the TPK with a median age of 60–61 vs. 70 years . A retrospective analysis including 41 patients with metastatic pancreatic ductal adenocarcinoma treated with at least 1 cycle of nab ‐paclitaxel plus gemcitabine in Italy reported a median PFS of 6.7 months and a median OS of 10 months …”

Tanshinone IIA enhances the inhibitory effect of imatinib on proliferation and motility of acute leukemia cell line TIB‑152 in�vivo and in�vitro by inhibiting the PI3K/AKT/mTOR signaling pathway

“…In recent years, plant-derived compounds have become clinically useful anticancer drugs (6)(7)(8). Tanshinone IIA (Tan IIA) is an important active ingredient in Salvia miltiorrhiza and there have been reports on its antitumor effects.…”