Real‐world outcomes of FOLFIRINOX vs gemcitabine and nab‐paclitaxel in advanced pancreatic cancer: A population‐based propensity score‐weighted analysis

Abstract

BackgroundIn Ontario, FOLFIRINOX (FFX) and gemcitabine + nab‐paclitaxel (GnP) have been publicly funded for first‐line unresectable locally advanced pancreatic cancer (uLAPC) or metastatic pancreatic cancer (mPC) since April 2015. We examined the real‐world effectiveness and safety of FFX vs GnP for advanced pancreatic cancer, and in uLAPC and mPC.MethodsPatients receiving first‐line FFX or GnP from April 2015 to March 2017 were identified in the New Drug Funding Program database. Baseline characteristics and outcomes were obtained through the Ontario Cancer Registry and other population‐based databases. Overall survival (OS) was assessed using Kaplan‐Meier and weighted Cox proportional hazard models, weighted by the inverse propensity score adjusting for baseline characteristics. Weighted odds ratio (OR) for hospitalization and emergency department visits (EDV) were estimated from weighted logistic regression models.ResultsFor 1130 patients (632 FFX, 498 GnP), crude median OS was 9.6 and 6.1 months for FFX and GnP, respectively. Weighted OS was improved for FFX vs GnP (HR = 0.77, 0.70‐0.85). Less frequent EDV and hospitalization were observed in FFX (EDV: 67.8%; Hospitalization: 49.2%) than GnP (EDV: 77.7%; Hospitalization: 59.3%). More frequent febrile neutropenia‐related hospitalization was observed in FFX (5.8%) than GnP (3.3%). Risk of EDV and hospitalization were significantly lower for FFX vs GnP (EDV: OR = 0.68, P = .0001; Hospitalization: OR = 0.76, P = .002), whereas the risk of febrile neutropenia‐related hospitalization was significantly higher (OR = 2.12, P = .001). Outcomes for uLAPC and mPC were similar.ConclusionIn the real world, FFX had longer OS, less frequent all‐cause EDV and all‐cause hospitalization, but more febrile neutropenia‐related hospitalization compared to GnP.

A phase I study of preoperative (neoadjuvant) chemotherapy with gemcitabine plus nab‑paclitaxel for resectable pancreatic cancer

“…However, it was recently demonstrated that FOLFIRINOX was associated with longer OS than GnP in patients with unresectable locally advanced or metastatic PDAC (38). Moreover, FOLFIRINOX treatment was reported to decrease the frequency of lymph node metastasis (30,39), consistent with our results supporting the effectiveness of NAC in patients with node-positive pancreatic head cancer (19).…”

Metabolism of pancreatic cancer: paving the way to better anticancer strategies

“…Although the clinical benefits produced by 5-FU are lower than those of gemcitabine, 5-FU is still widely applied in treating pancreatic cancer partly due to its lower toxicity [139]. In recent years, increasing evidence has shown that the FOLFIRINOX regimen (5-FU, leucovorin, irinotecan and oxaliplatin) can achieve longer overall survival than gemcitabine-based therapy, especially in patients with good status [140][141][142][143][144]. Compared with other chemotherapy regimens, the underlying mechanism of gemcitabine resistance is relatively well documented [131].…”

Poor Outcome and Prolonged Hospital Stay after the Diagnosis of Liver Abscesses in Hospitalized Cancer Patients: A Single Center Experience

“…However, liver abscesses diagnosis in cancer patients, in this study, were associated with a long hospitalization, with a mean hospital stay of 30.5 days (95% CI: 20.3-40.7 days). The diagnosis of liver abscesses in this group of patients was also associated with poor outcome [8][9][10][11]. In the entire study population, median OS was only 6 months (95% CI: 1-12 months); and the OS probability at 18 months was only 27%.…”