Progression-free Survival of Advanced Pancreatic Cancer in Iraqi Patients Treated with First-line Chemotherapy

Abstract

Background: Pancreatic cancer is a highly aggressive cancer. According to the latest data published by the World Health Organization, the number of new cases in 2020 in Iraq was 674 and represented 2% of all new cancer cases. Most of the pancreatic adenocarcinomas have spread outside the pancreas at the time of diagnosis. Progression free survival is the time between the date of diagnosis to disease progression or death. The current study aims to compare progression free survival between three chemotherapy regimens; Gemcitabine, Gemcitabine/Nab-paclitaxel and FOLFIRINOX of advanced and metastatic pancreatic cancer in Iraqi patients. Methods: Patients were divided into three groups; patients who will receive Gemcitabine, those who will receive Gemcitabine/Nab-paclitaxel, and patients who will receive FOLFIRINOX. The patients were observed for disease progression by computed tomography which was performed every three months for the tumor response and progression. Results: In the Gemcitabine, Gemcitabine/Nab-paclitaxel, and FOLFIRINOX groups, the median Progression Free Survivals were (4, 5, and 5.7 months, respectively; p is less than 0.05), where FOLFIRINOX was superior to Gemcitabine monotherapy and Gemcitabine/Nab-paclitaxel. In addition, neutropenia, febrile neutropenia, diarrhoea, nausea, vomiting, fatigue, hypokalaemia and neuropathy were highly in the FOLFIRINOX-treated patients than in both Gemcitabine and Gemcitabine/Nab-paclitaxel groups of patients. However, anaemia and thrombocytopenia were higher with Gemcitabine and Gemcitabine/Nab-paclitaxel than were with FOLFIRINOX. Conclusion: The median Progression free survival is better for the Gemcitabine/Nab-paclitaxel and FOLFIRNOX than for Gemcitabine alone. Also, adverse effects are more common with FOLFIRINOX than with other first-line chemotherapeutic agents.