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Williet N, Petrillo A, Roth G, Ghidini M, Petrova M, Forestier J, Lopez A, Thoor A, Weislinger L, De Vita F, Taieb J, Phelip JM. Gemcitabine/Nab-Paclitaxel versus FOLFIRINOX in Locally Advanced Pancreatic Cancer: A European Multicenter Study. Cancers (Basel) 2021; 13:cancers13112797. [PMID: 34199796 PMCID: PMC8200096 DOI: 10.3390/cancers13112797] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary 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). 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. Abstract 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.
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Affiliation(s)
- Nicolas Williet
- Department of Hepatogastroenterology, University Hospital of Saint-Etienne, 42000 Saint-Etienne, France;
- Correspondence:
| | - Angelica Petrillo
- Department of Precision Medecine, University of Study of Campania «L. Vanvitelli», 81100 Naples, Italy; (A.P.); (F.D.V.)
| | - Gaël Roth
- Hepato-Gastroenterology Department, University Hospital of Grenoble, 38043 Grenoble, France; (G.R.); (A.T.)
| | - Michele Ghidini
- Department of Medical Oncology, Cancer Center, Hospital of Cremona, 26100 Cremona, Italy;
| | - Mila Petrova
- Department of Medical Oncology, MHAT Nadezhda, 1220 Sofia, Bulgaria;
| | - Julien Forestier
- Department of Medical Oncology, Hôpital Edouard Herriot, 69622 Lyon, France;
| | - Anthony Lopez
- Hepato-Gastroenterology Department, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; (A.L.); (L.W.)
| | - Audrey Thoor
- Hepato-Gastroenterology Department, University Hospital of Grenoble, 38043 Grenoble, France; (G.R.); (A.T.)
| | - Lucie Weislinger
- Hepato-Gastroenterology Department, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; (A.L.); (L.W.)
| | - Ferdinando De Vita
- Department of Precision Medecine, University of Study of Campania «L. Vanvitelli», 81100 Naples, Italy; (A.P.); (F.D.V.)
| | - Julien Taieb
- Department of Gastroenterology and Gastro-Intestinal Oncology, Hôpital Européen Georges-Pompidou, APHP, Paris Descartes University, Sorbonne Paris Cité, 75004 Paris, France;
| | - Jean Marc Phelip
- Department of Hepatogastroenterology, University Hospital of Saint-Etienne, 42000 Saint-Etienne, France;
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