Outcomes in metastatic pancreatic adenocarcinoma (MPAC) patients treated with FOLFIRINOX (FFX)/FOLFOX(FX) and gemcitabine + nab-paclitaxel (NabG).

Abstract

397 Background: Standard front line (FL) chemotherapy regimens for MPAC include FOLFIRINOX (FFX)/FOLFOX(FX) and Nab-paclitaxel plus Gemcitabine (NabG). Outcome data in patients treated with both FFX/FX and NabG has not been well characterized. We retrospectively reviewed our single institution experience in MPAC patients treated with FFX/FX and NabG in either sequence. Methods: All MPAC patients treated with FFX/FX or NabG, in either sequence, from 1/1/11 to 12/31/14 at the Froedtert and Medical College of Wisconsin (MCW) Clinical Cancer Center were identified and their charts reviewed. This study was approved by the Froedtert & MCW Institutional Review Board. Results: Among the 64 patients reviewed, median age at diagnosis was 62 years, 64.1% were male and 95.3% were Caucasian. Median Ca19-9 and CEA at diagnosis were 855 and 10.4 respectively. Liver, lung and peritoneal metastases were appreciated in 87.5%, 20.3% and 35.9% of patients. 37/64 (57.8%) patients received second line (SL) therapy. Response Rate (RR) with FFX/FX and NabG in both FL and SL therapy are summarized in the Table. The median Progression Free Survival (PFS) with FL therapy was 3.7 months and 3.5 months with SL therapy. Median overall survival (OS) of the entire cohort was 8.7 months. In patients who received 2 lines of therapy the median OS was 12.1 months. Median OS in patients who received only one line of therapy was 4.1 months. Conclusions: In patients with MPAC, sequential therapy with FFX/FX and NabG is both feasible and effective in either sequence. RR and DCR with these regimens, while modest, are acceptable in the SL setting. Patients who received two lines of therapy have a substantially better OS than patients who receive one line of therapy, suggesting a more favorable tumor biology in the former population. [Table: see text]