Clinical outcome of patients with inoperable pancreatic cancer treated with FOLFIRINOX or gemcitabine plus Nab‑paclitaxel as a first‑line therapy: A retrospective analysis

Hiroyuki Sakaguchi,Azusa Tanimoto,Chiaki Suzuki,Koshiro Ohtsubo,Naohiro Yanagimura,Seiji Yano,Shigeki Sato,Akihiro Nishiyama,Shinji Takeuchi,Kaname Yamashita,Yohei Takumi

doi:10.3892/mi.2021.8

Abstract

The present study aimed to evaluate the clinical benefits of leucovorin, 5‑fluorouracil, irinotecan and oxaliplatin (FOLFIRINOX) vs. gemcitabine plus Nab‑paclitaxel (GnP) as a first‑line therapy for patients with inoperable pancreatic cancer. For this purpose, in‑house data available for 45 patients who received FOLFIRINOX or GnP as first‑line treatment between 2014 and 2019 were retrospectively analyzed. In total, 21 and 24 patients received FOLFIRINOX and GnP, respectively. Although there were no significant differences in the median progression‑free survival, the median overall survival was longer in the FOLFIRINOX group than in the GnP group (16.7 vs. 7.2 months). A total of 14 patients received FOLFIRINOX followed by GnP, whereas 3 patients received GnP followed by FOLFIRINOX. All patients who did not switch to second‑line therapy owing to poor feasibility were included in the GnP group. The data indicated that patients receiving GnP as first‑line therapy were less likely to switch to FOLFIRINOX and, consequently, had a worse prognosis.

Highlights

The 5‐year relative survival rate for all stages combined in pancreatic cancer is lower (9%) than that for other types of cancer reported in the United States [1]
The present study demonstrated that FOLFIRINOX noticeably improved the prognosis of patients with inoperable pancreatic cancer compared with gemcitabine plus Nab‐paclitaxel (GnP) when either of the two therapies was used as a first‐line therapy
In 41 patients receiving second‐line therapy, 14 out of the 21 patients switched from FOLFIRINOX to GnP, whereas only 3 out of 20 patients switched from GnP to FOLIRINOX (Table III)

Summary

Introduction

The 5‐year relative survival rate for all stages combined in pancreatic cancer is lower (9%) than that for other types of cancer reported in the United States [1]. Each group of patients who participated in these studies had distinct background characteristics; whether FOLFIRINOX or GnP should be used as first‐line chemo‐ therapy remains an open research conundrum. Liposomal irinotecan (nal‐IRI) with 5‐fluorouracil and leucovorin following gemcitabine‐based therapy has been approved in several countries due to its high antitumor activity and feasibility for use in patients with inoperable pancreatic cancer [7]. It can be presumed that combination therapy will be more commonly used following GnP treatment failure, whereas the clinical validity of FOLFIRINOX, which includes irinotecan, 5‐fluorouracil and leucovorin, as a second‐line therapy following GnP in practice, remains controversial [8,9].

Patients and methods

Results

Discussion

Availability of data and materials