Abstract
Background: Gemcitabine/nab-paclitaxel and Folfirinox are standard of care of treatment of metastatic pancreatic cancer as first and second line in patients with good performance status or “fit”. Progression-free survival shows similar data in both chemotherapy regimens. No data on the better treatment sequence is available. Methods: We have retrospectively analyzed 43 patients with histological diagnosis of metastatic pancreatic adenocarcinoma and an Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1. 23 (53,5%) and 20 (46,5%) of 43 patients received Folfirinox and Gemcitabine/Nab-paclitaxel as first line chemotherapy respectively. Only 19 (44,1%) patients, after progression disease, started second line chemotherapy. 8 patients received Folfirinox, whereas 11 patients were treated with Gemcitabine Nab-paclitaxel as second line regardless of prior chemotherapy. The sequence of chemotherapy Folfirinoxàgemcitabine/Nab-paclitaxel versus Gemcitabine/Nab-paclitaxelà Folfirinox was administered to 10 patients 5 for both, respectively. Results: Median Progression-Free Survival was 5 months in the Folfirinox group as compared with 6 months in gemcitabine Nab-paclitaxel group (hazard ratio for disease progression, 0.83; 95% CI, 0.34 to 1.32; P value = 0.95). No difference between the two groups were identified in first line. The median of progression-free survival in second line was 2.5 months in the Folfirinox group and 4 months in the Gemcitabine/nab-paclitaxel. Hazard ratio for second disease progression was 0.62; 95% CI, 0.24 to 1.00; P value = 0.03. The median overall survival in patients with the sequence of chemotherapy Folfirinoxàgemcitabine/Nab-paclitaxel versus Gemcitabine/Nab-paclitaxelà Folfirinox was retrospectively 8 months and 11 months. Conclusion: In this retrospective study, similar progression-free survival we observed between Folfirinox group and Gemcitabine/Nab-paclitaxel group in first line metastatic pancreatic cancer. These data need to be confirm in prospective randomized trial.
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