Abstract
Background: There have not been any head-to-head prospective studies to compare the effects of different chemotherapy regimens as first-line treatments for unresectable pancreatic cancer (UPC). We aimed to compare the effectiveness of nab-paclitaxel plus gemcitabine, mFOLFIRINOX and gemcitabine plus oxaliplatin (GEMOX) as first-line treatments by using real-world data from Chinese patients. Methods: We retrospectively included patients with UPC treated with nab-paclitaxel plus gemcitabine, mFOLFIRINOX or GEMOX as a first-line treatment at Sun Yat-sen University Cancer Center. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR) were assessed. Results: A total of 117 patients were administered nab-paclitaxel plus gemcitabine (n = 62), mFOLFIRINOX (n = 30) or GEMOX (n = 25) as first-line chemotherapy. The median OS was 11.1, 10.1 and 10.2 months (p = 0.75) in the nab-paclitaxel plus gemcitabine, mFOLFIRINOX and GEMOX, respectively. The ORR was similar among the three groups (24%, 23% and 32%, p = 0.76) and the DCR was higher in the nab-paclitaxel-gemcitabine group (82%) than the other two groups (60% and 64%, p = 0.04). The most common adverse events of grade 3 or 4 were neutropenia (32%, 28% and 5%), peripheral neuropathy (13%, 16% and 0) and fatigue (9%, 16% and 5%). Febrile neutropenia occurred in 2%, 4% and 5% of the patients in the three groups. Conclusion: In the first line treatment of UPC, our results suggest that nab-paclitaxel plus gemcitabine was associated with a higher DCR than mFOLFIRINOX or GEMOX, while all groups demonstrated similar OS, PFS and ORR.
Highlights
Pancreatic adenocarcinoma is the sixth leading cause of cancer death in China, with 116,291 new patients and 110,390 deaths in 2018
Gemcitabine combined with oxaliplatin (GEMOX) was the first combined treatment shown to be superior to gemcitabine alone from the clinical benefit, objective response rate (ORR) and progression-free survival (PFS) perspective, it failed to give evidence of a statistically significant advantage in terms of overall survival (OS, 9.0 versus 7.1 months; p = 0.13) [3]
A total of 117 patients who were accessible for survival analysis were enrolled in this study from March 2005 to March 2018, including 62 patients in the nab-paclitaxel-gemcitabine group, 30 patients in the mFOLFIRINOX group, and 25 patients in the gemcitabine plus oxaliplatin (GEMOX) group
Summary
Pancreatic adenocarcinoma is the sixth leading cause of cancer death in China, with 116,291 new patients and 110,390 deaths in 2018. In 2011, a regimen containing oxaliplatin, irinotecan, fluorouracil, and leucovorin (FOLFIRINOX) was introduced as a new first-line regimen for patients with UPC that extended survival time by 4.3 months compared to treatment with gemcitabine alone [4]. We aimed to compare the effectiveness of nab-paclitaxel plus gemcitabine, mFOLFIRINOX and gemcitabine plus oxaliplatin (GEMOX) as first-line treatments by using real-world data from Chinese patients. Methods: We retrospectively included patients with UPC treated with nab-paclitaxel plus gemcitabine, mFOLFIRINOX or GEMOX as a first-line treatment at Sun Yat-sen University Cancer Center. Conclusion: In the first line treatment of UPC, our results suggest that nab-paclitaxel plus gemcitabine was associated with a higher DCR than mFOLFIRINOX or GEMOX, while all groups demonstrated similar OS, PFS and ORR
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