Abstract

Simple SummaryGemcitabine/nab-paclitaxel (GN) and FOLFIRINOX (FFX) are two standard first-line therapies for metastatic pancreatic cancer (PC) but have rarely been compared, especially in patients with locally advanced PC (LAPC). By carefully selecting patients, it is likely these two regimens lead to similar survival outcomes. Through a multicenter European study, biases regarding practice habits are reduced. Hence, we observed no difference between GN and FFX as first-line treatments in patients with LAPC in terms of either survival, tumor response or tumor resection rate. Further trials are needed to confirm these data.Background: Gemcitabine/nab-paclitaxel (GN) and FOLFIRINOX (FFX) are two standard first-line therapies for metastatic pancreatic cancer (PC) but have rarely been compared, especially in patients with locally advanced PC (LAPC). Methods: This is a retrospective European multicenter study including patients with LAPC treated with either GN or FFX as the first-line therapy between 2010 and 2019. Coprimary objectives were progression-free survival (PFS) and overall survival (OS), both estimated using the Kaplan–Meier method. Results: A total of 147 patients (GN: n = 60; FFX: n = 87) were included. Tumor resection rates were similar between the two groups (16.7% vs. 16.1%; p = 1), with similar R0 resection rates (88.9%). Median PFS rates were not statistically different: 9 months (95% CI: 8–13.5) vs. 12.1 months (95% CI: 10.1–14.6; p = 0.8), respectively. Median OS rates were 15.7 months (95% CI: 12.6–20.2) and 16.7 months (95% CI: 14.8–20.4; p = 0.7), respectively. Abdominal pain at the baseline (HR = 2.03, p = 0.03), tumors located in the tail of the pancreas (HR = 4.35, p = 0.01), CA19-9 > 200 UI/L (HR = 2.03, p = 0.004) and tumor resection (HR = 0.37, p = 0.007) were independent prognostic factors for PFS, similarly to OS. CA19-9 ≤ 200 UI/L (OR = 2.6, p = 0.047) was predictive of the tumor response. Consolidation chemoradiotherapy, more often used in the FFX group (11.7% vs. 50.6%; p < 0.001), was not predictive. Conclusion: This retrospective study did not show any difference between GN and FFX as the first-line treatment in patients with LAPC.

Highlights

  • Pancreatic ductal adenocarcinoma (PDAC) is becoming the second cause of cancerrelated deaths in Europe and America [1,2]

  • Numerous retrospective and some prospective studies conducted on the locally advanced PC (LAPC) treated using these regimens have shown survival outcomes that appear to be clearly better than those observed in studies evaluating gemcitabine alone [6,7,12,13,14,15]

  • According to meta-analyses and some prospective studies, high response rates related to these chemotherapy regimens lead to secondary surgery in 15–28% of cases in LAPC [14,15,16,17,18] compared to 5–10% under gemcitabine

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Summary

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is becoming the second cause of cancerrelated deaths in Europe and America [1,2]. According to meta-analyses and some prospective studies, high response rates related to these chemotherapy regimens lead to secondary surgery in 15–28% of cases in LAPC [14,15,16,17,18] compared to 5–10% under gemcitabine For these reasons, FFX and GN are highly recommended for borderline resectable tumors and are an option for LAPC [3,4,5]. Based on this background, this European multicenter study aimed to evaluate survival outcomes in patients with LAPC treated either with GN or FFX in a real-life setting.

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