Abstract
BackgroundFOLFIRINOX (FFX) and Gemcitabine plus nab-paclitaxel (GnP) have been recommended as the first-line chemotherapy for metastatic pancreatic cancer (mPC). However, the evidence is lacking comparing not only two regimens, but also sequential treatment (FFX–GnP vs. GnP–FFX).MethodsData of 528 patients (FFX, n = 371; GnP, n = 157) with mPC were collected retrospectively. Propensity score matching was conducted to alleviate imbalance of the two groups. Overall survival (OS), progression free survival (PFS), and toxicity of patients were analyzed.ResultsIn the whole population, OS (12.5 months vs. 10.3 months, P = 0.05) and PFS (7.1 months vs. 5.8 months, P = 0.02) were longer in the FFX group before matching and after matching (OS: 11.8 months vs. 10.3 months, P = 0.02; PFS: 7.2 months vs. 5.8 months, P < 0.01). For sequential treatment, OS and PFS showed no significant difference. Interruptions of chemotherapy due to toxicities were more frequent (6.8 vs. 29.3%, P < 0.001) in the GnP group, and cessation of chemotherapy showed a significant association with mortality (z = − 1.94, P = 0.03).ConclusionsFFX achieved a longer overall survival than GnP in mPC, but not in the comparison for sequential treatment. More frequent adverse events followed by treatment interruptions during GnP might lead to a poor survival outcome. Therefore, FFX would be a better first-line treatment option than GnP for mPC.
Highlights
FOLFIRINOX (FFX) and Gemcitabine plus nab-paclitaxel (GnP) have been recommended as the firstline chemotherapy for metastatic pancreatic cancer
Since single-agent gemcitabine was introduced as an effective treatment option in 1997, combination regimens are currently considered to be superior to monotherapy for advanced pancreatic cancer [3, 4]
It has been demonstrated that FOLFIRINOX (FFX, a combination of 5-fu, leucovorin, irinotecan, and oxaliplatin) and gemcitabine plus nab-paclitaxel (GnP) can significantly improve response rates and survival benefits compared to gemcitabine only in the randomized phase III PRODIGE and MPACT trials, respectively [5, 6]
Summary
FOLFIRINOX (FFX) and Gemcitabine plus nab-paclitaxel (GnP) have been recommended as the firstline chemotherapy for metastatic pancreatic cancer (mPC). It has been demonstrated that FOLFIRINOX (FFX, a combination of 5-fu, leucovorin, irinotecan, and oxaliplatin) and gemcitabine plus nab-paclitaxel (GnP) can significantly improve response rates and survival benefits compared to gemcitabine only in the randomized phase III PRODIGE and MPACT trials, respectively [5, 6]. These two combination regimens are recommended as first-line treatment for metastatic pancreatic cancer (mPC) [7,8,9]
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