Skip to main content

Advertisement

SpringerLink
Log in

Nab-paclitaxel plus gemcitabine versus FOLFIRINOX as the first-line chemotherapy for patients with metastatic pancreatic cancer: retrospective analysis

  • SHORT REPORT
  • Published:
Investigational New Drugs Aims and scope Submit manuscript

Summary

Purpose nab-paclitaxel plus gemcitabine (AG) and FOLFIRINOX have been established as standard first-line treatment in metastatic pancreatic cancer (mPC). We performed retrospective analysis comparing the efficacies of AG and FOLFIRINOX in daily practice setting. Materials and Methods We analyzed 308 patients who presented initially as mPC and received AG (n = 149) or FOLFIRINOX (n = 159) as first-line treatment between 2013 and 2016. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Result There were no significant differences between the two groups in terms of baseline characteristics, except older age and higher Charlson Comorbidity Index (CCI) score in AG group. The response rates (34% vs 34%) and median PFS (6.8 vs 5.1 months) were comparable between two groups (p = 0.88 and p = 0.19, respectively), while median OS was significantly better with AG than FOLFIRINOX (11.4 vs 9.6 months; p = 0.002). Elevated baseline CA19–9 level and liver metastasis were independent adverse prognostic factors for PFS and OS. In subgroup analyses, PFS with AG was better in patients with age ≥ 65 years, peritoneal metastasis, and higher CCI than that with FOLFIRINOX. Conclusion Both AG and FOLFIRINOX showed comparable efficacy outcomes in daily practice setting. AG might be preferentially considered in patients with peritoneal metastasis, comorbid medical conditions or old age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C et al (2017) Global, regional, and National Cancer Incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 Cancer groups, 1990 to 2015. JAMA Oncol 3:524–525. https://doi.org/10.1001/jamaoncol.2016.5688

    Article  PubMed Central  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67:7–30. https://doi.org/10.3322/caac.21387

    Article  PubMed  Google Scholar 

  3. Jung K-W, Won Y-J, Oh C-M, Kong HJ, Lee DH, Lee KH, The Community of Population-Based Regional Cancer Registries (2017) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2014. Cancer Res Treat 49:292–305. https://doi.org/10.4143/crt.2017.118

    Article  PubMed  PubMed Central  Google Scholar 

  4. Burris HA, Moore MJ, Andersen J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15:2403–2413. https://doi.org/10.1200/JCO.1997.15.6.2403

    Article  PubMed  CAS  Google Scholar 

  5. Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, Au HJ, Murawa P, Walde D, Wolff RA, Campos D, Lim R, Ding K, Clark G, Voskoglou-Nomikos T, Ptasynski M, Parulekar W, National Cancer Institute of Canada Clinical Trials Group (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada clinical trials group. J Clin Oncol 25:1960–1966. https://doi.org/10.1200/JCO.2006.07.9525

    Article  PubMed  CAS  Google Scholar 

  6. Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, Adenis A, Raoul JL, Gourgou-Bourgade S, de la Fouchardière C, Bennouna J, Bachet JB, Khemissa-Akouz F, Péré-Vergé D, Delbaldo C, Assenat E, Chauffert B, Michel P, Montoto-Grillot C, Ducreux M, Groupe Tumeurs Digestives of Unicancer, PRODIGE Intergroup (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825

    Article  PubMed  CAS  Google Scholar 

  7. Hoff Von DD, Ervin T, Arena FP et al (2013) Increased survival in pancreatic Cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369:1691–1703. https://doi.org/10.1056/NEJMoa1304369

    Article  CAS  Google Scholar 

  8. Mahaseth H, Brutcher E, Kauh J, Hawk N, Kim S, Chen Z, Kooby DA, Maithel SK, Landry J, el-Rayes BF (2013) Modified FOLFIRINOX regimen with improved safety and maintained efficacy in pancreatic adenocarcinoma. Pancreas 42:1311–1315. https://doi.org/10.1097/MPA.0b013e31829e2006

    Article  PubMed  CAS  Google Scholar 

  9. Stein SM, James ES, Deng Y, Cong X, Kortmansky JS, Li J, Staugaard C, Indukala D, Boustani AM, Patel V, Cha CH, Salem RR, Chang B, Hochster HS, Lacy J (2016) Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer. Br J Cancer 114:737–743. https://doi.org/10.1038/bjc.2016.45

    Article  PubMed  CAS  Google Scholar 

  10. Tempero MA, Malafa MP, Al-Hawary M et al (2017) Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 15:1028–1061. https://doi.org/10.6004/jnccn.2017.0131

    Article  Google Scholar 

  11. Ducreux M, Cuhna AS, Caramella C, Hollebecque A, Burtin P, Goéré D, Seufferlein T, Haustermans K, van Laethem JL, Conroy T, Arnold D (2015) Cancer of the pancreas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26:v56–v68. https://doi.org/10.1093/annonc/mdv295

    Article  PubMed  Google Scholar 

  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  13. Kim BJ, Hyung J, Yoo C, Kim KP, Park SJ, Lee SS, Park DH, Song TJ, Seo DW, Lee SK, Kim MH, Park JH, Cho H, Ryoo BY, Chang HM (2017) Prognostic factors in patients with advanced biliary tract cancer treated with first-line gemcitabine plus cisplatin: retrospective analysis of 740 patients. Cancer Chemother Pharmacol 80:209–215. https://doi.org/10.1007/s00280-017-3353-2

    Article  PubMed  CAS  Google Scholar 

  14. De Vita F, Ventriglia J, Febbraro A et al (2016) NAB-paclitaxel and gemcitabine in metastatic pancreatic ductal adenocarcinoma (PDAC): from clinical trials to clinical practice. BMC Cancer 16:709. https://doi.org/10.1186/s12885-016-2671-9

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Montes A, Villarroel P, Ayerbes M, Gómez JC, Aldana GQ, Tuñas LV, Fernández MS, Fernández MJ (2017) Prognostic and predictive markers of response to treatment in patients with locally advanced unresectable and metastatic pancreatic adenocarcinoma treated with gemcitabine/nab-paclitaxel: results of a retrospective analysis. J Can Res Ther 13:240–246. https://doi.org/10.4103/0973-1482.181181

    Article  CAS  Google Scholar 

  16. Ho MY, Kennecke HF, Renouf DJ, Cheung WY, Lim HJ, Gill S (2017) Defining eligibility of FOLFIRINOX for first-line metastatic pancreatic adenocarcinoma (MPC) in the province of British Columbia. Am J Clin Oncol 40:552–554. https://doi.org/10.1097/COC.0000000000000205

    Article  PubMed  CAS  Google Scholar 

  17. Rombouts SJ, Mungroop TH, Heilmann MN, van Laarhoven H, Busch OR, Molenaar IQ, Besselink MG, Wilmink JW (2016) FOLFIRINOX in locally advanced and metastatic pancreatic Cancer: a single Centre cohort study. J Cancer 7:1861–1866. https://doi.org/10.7150/jca.16279

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Chiorean EG, Hoff Von DD, Tabernero J et al (2016) Second-line therapy after nab-paclitaxel plus gemcitabine or after gemcitabine for patients with metastatic pancreatic cancer. Br J Cancer 115:188–194. https://doi.org/10.1038/bjc.2016.185

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Bauer TM, El-Rayes BF, Li X et al (2012) Carbohydrate antigen 19-9 is a prognostic and predictive biomarker in patients with advanced pancreatic cancer who receive gemcitabine-containing chemotherapy. Cancer 119:285–292. https://doi.org/10.1002/cncr.27734

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Stocken DD, Hassan AB, Altman DG, Billingham LJ, Bramhall SR, Johnson PJ, Freemantle N (2008) Modelling prognostic factors in advanced pancreatic cancer. Br J Cancer 99:883–893. https://doi.org/10.1038/sj.bjc.6604568

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Tabernero J, Chiorean EG, Infante JR, Hingorani SR, Ganju V, Weekes C, Scheithauer W, Ramanathan RK, Goldstein D, Penenberg DN, Romano A, Ferrara S, von Hoff DD (2015) Prognostic factors of survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic Cancer. Oncologist 20:143–150. https://doi.org/10.1634/theoncologist.2014-0394

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Maisey NR, Norman AR, Hill A, Massey A, Oates J, Cunningham D (2005) CA19-9 as a prognostic factor in inoperable pancreatic cancer: the implication for clinical trials. Br J Cancer 93:740–743. https://doi.org/10.1038/sj.bjc.6602760

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Funding

This study was supported by grants from the Asan Institute for Life Sciences, Asan Medical Center in Seoul, Korea (2017–728).

Author information

Author notes

  1. Jihoon Kang

    Present address: Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

  2. Changhoon Yoo and Kyu-pyo Kim contributed equally to this work as co-corresponding authors.

Authors and Affiliations

  1. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Jihoon Kang, Inhwan Hwang, Changhoon Yoo, Kyu-pyo Kim, Jae Ho Jeong, Heung-Moon Chang & Baek-Yeol Ryoo

  2. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Sang Soo Lee, Do Hyun Park, Tae Jun Song, Dong Wan Seo, Sung Koo Lee & Myung-Hwan Kim

  3. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Seung-Mo Hong

  4. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Sang Hyun Shin, Dae Wook Hwang, Ki Byung Song, Jae Hoon Lee & Song Cheol Kim

Authors
  1. Jihoon Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Inhwan Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Changhoon Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyu-pyo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jae Ho Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Heung-Moon Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sang Soo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Do Hyun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tae Jun Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Dong Wan Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sung Koo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Myung-Hwan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Seung-Mo Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Sang Hyun Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Dae Wook Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Ki Byung Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Jae Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Song Cheol Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Baek-Yeol Ryoo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Changhoon Yoo or Kyu-pyo Kim.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Additional information

Jihoon Kang and Inhwan Hwang should be considered as co-first authors

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kang, J., Hwang, I., Yoo, C. et al. Nab-paclitaxel plus gemcitabine versus FOLFIRINOX as the first-line chemotherapy for patients with metastatic pancreatic cancer: retrospective analysis. Invest New Drugs 36, 732–741 (2018). https://doi.org/10.1007/s10637-018-0598-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10637-018-0598-5

Keywords

Search

Navigation