Second-line treatment of modified FOLFIRINOX or nab-paclitaxel plus gemcitabine for metastatic pancreatic adenocarcinoma.

Abstract

458 Background: Both FOLFIRINOX (FFX) and Nab-paclitaxel plus Gemcitabine(GnP) standard treatment in first-line treatment of metastatic pancreatic adenocarcinoma (MPA). It could be of interest to use them consecutively, knowing that there is currently no standard for second-line treatments for MPA. The aim of this study was to compare second-line modified FFX (mFFX) after GnP failure with second-line GnP after mFFX failure. Methods: From January 2015 to Jul 2017, medical records were retrospectively reviewed for consecutive patients receiving mFFX or GnP for a histologically proven MPA after failure of GnP or mFFX respectively. Patients were treated with mFFX (intravenous oxaliplatin 85 mg/m2, irinotecan 150 mg/m2, 5-FU infusion 2,400 mg/m2 over 46 h, no bolus 5-FU) or GnP (Gemcitabine 1000 mg/m2/, nab-paclitaxel 125mg/m2 d1,8 15) until disease progression, patient refusal or unacceptable toxicity. Results: Second-line mFFX was administered to 50 patients and GnP was 25 patients. At baseline of second-line treatment, there was no difference in patient’s characteristics between mFFX group and GnP group. No significant difference in the response rate (mFFX, 16.6% vs. GnP, 10.5%, P = 0.63) or the disease control rate (mFFX, 50% vs. GnP, 64%, P = 0.82) was seen between the two groups. Median Progression free survival of GnP/mFFx were 4.3 months/4.6 months (p=0.89) and median survival (OS) from the 2nd line treatment of GnP/mFFx were 10.4 months/10.8 months (p=0.65) and OS from the first-line treatment of GnP/mFFx were 20.6 months/16.5 months (p=0.34). No toxic death occurred in both groups. There was no difference in the incident of adverse event between mFFX group and GnP group. Conclusions: Second-line mFFX and GnP achieved similar disease control and survival in unresectable pancreatic cancer. The use of the FFX and GnP in sequence is an attractive option to maximize disease control and survival. We need the clinical trial to compare with mFFX and GnP in sequence to guide the selection of initial chemotherapy.

Gemcitabine Plus Nab-Paclitaxel as Second-Line Chemotherapy following FOLFIRINOX in Patients with Unresectable Pancreatic Cancer: A Single-Institution, Retrospective Analysis

“…Moreover, previous studies reported that median PFS and OS of second-line GnP after FFX were 2.4-6.4 and 4.6-16.2 months, respectively (Table 4) [8][9][10][11][12][13][14][15][16][17][18][19]. PFS in the present study was comparable to the previous reports, and OS in the present study was considered good.…”

“…On the other hand, there has been no large prospective study of second-line treatment after FFX. Only a few studies of second-line GnP after FFX have been reported [8][9][10][11][12][13][14][15][16][17][18][19]. In these reports, median PFS was 2.4-6.4 months.…”

Systematic review and meta-analysis of gemcitabine-based chemotherapy after FOLFIRINOX in advanced pancreatic cancer

“…6 journals.sagepub.com/home/tam A total of 11 studies assessed the DCR of gemcitabine-based chemotherapy (412 patient). 12,22,[25][26][27][28][29][30][31][32][33] Radiological response evaluation took place every 8 weeks in four studies 22,26,27,33 and in one study the median time to first disease response assessment was 8.9 weeks. 32 In the remaining investigations, time to first disease response evaluation was not stated.…”

“…12,22,[25][26][27][28][29][30][31][32][33][34][35] Six studies were multicentric investigations 22,23,26,27,31,34 and seven were available solely as posters or electronic abstracts. 11,24,25,[29][30][31]34 S7 illustrates treatment characteristics in the selected studies. Amongst noncomparative studies, five evaluated the activity of single-agent gemcitabine [25][26][27]33,35 and eight assessed the activity of gemcitabine plus nab-paclitaxel.…”

“…Ten studies evaluated the ORR of gemcitabine-based chemotherapy (370 patients). 12,22,[25][26][27][28][29][30][31][32] Seven used RECIST criteria to assess response. 22,[25][26][27][28]31,32 In the remaining studies, the method of response evaluation was not described.…”