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Carrato A, Pazo-Cid R, Macarulla T, Gallego J, Jiménez-Fonseca P, Rivera F, Cano MT, Rodríguez Garrote M, Pericay C, Diaz I, Layos L, Graña B, Iranzo V, Gallego-Jimenez I, Garcia-Carbonero R, Alvarez Alejandro M, Ruiz de Mena I, GUILLEN PONCE CARMEN, Aranda E. Sequential nab-paclitaxel/gemcitabine followed by modified FOLFOX for first-line metastatic pancreatic cancer: The SEQUENCE trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4022 Background: Sequential treatment with nab-paclitaxel, gemcitabine followed by oxaliplatin, leucovorin and 5-fluorouracil ( nab-P/Gem-mFOLFOX) have shown a good safety profile and clinical activity in metastatic pancreatic ductal adenocarcinoma (mPDAC) in a previously published phase I SEQUENCE trial. Methods: We have compared nab-P/Gem-mFOLFOX to the standard nab-P/Gem in first-line treatment, in an open-label multi-institutional prospective randomised phase II trial in patients with untreated mPDAC from 14 Spanish hospitals. Patients were allocated 1:1 to nab-paclitaxel (125 mg/m2) plus gemcitabine (1000 mg/m2) on days 1, 8 and 15, followed by modified FOLFOX-6 (oxaliplatin [85 mg/m2], L-leucovorin [200 mg/m2] or racemic leucovorin [400 mg/m2], 5-fluorouracil bolus [400 mg/m2], and 5-fluorouracil 48-hour continuous infusion [2400 mg/m2]) on day 29 of a 6-week cycle or nab-paclitaxel (125 mg/m2) plus gemcitabine (1000 mg/m2) on days 1, 8 and 15 of a 4-week cycle. The primary endpoint was the 12-month overall survival rate (OS) in randomised patients. EudraCT number 2014-005350-19; ClinicalTrial.gov identifier NCT02504333. Results: Between July 27, 2017, and April 16, 2019, 182 patients were screened and 157 randomised: 78 to nab-P/Gem-mFOLFOX and 79 to nab-P/Gem. Patients receiving nab-P/Gem-mFOLFOX showed a significantly higher 12-month, and 24-month OS (95% CI): 55.3% (44.2-66.5%) versus 35.4% (24.9-46.0%) (p = 0.016), and 22.4% (13.0-31.8%) versus 7.6% (1.8-13.4%) (p = 0.012), respectively. The median OS (95% CI) reached 13.2 (10.1-16.2) months with nab-P/Gem-mFOLFOX and 9.7 (7.5-12.0) months with nab-P/Gem (HR = 0.676, 95% CI 0.483-0.947, p = 0.023). 39.7% patients in the nab-P/Gem-mFOLFOX group and 54.4% in nab-P/Gem group received subsequent anticancer treatments. Safety was comparable except for grade ≥3 neutropenia (46.1% versus 24.1%, p = 0.004) and grade ≥3 thrombocytopenia (23.7% versus 7.6%, p = 0.007) that were higher in the nab-P/Gem-mFOLFOX regimen. Two (2.6%) patients died due to adverse events in the nab-P/Gem-mFOLFOX arm. Conclusions: Nab-P/Gem-mFOLFOX showed significantly higher clinical activity than the standard nab-P/Gem treatment, with a manageable safety profile. This regimen represents a feasible and efficient new option for first-line treatment of mPDAC. Clinical trial information: NCT02504333.
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Affiliation(s)
- Alfredo Carrato
- IRYCIS, CIBERONC, Alcalá University, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Roberto Pazo-Cid
- Aragon Institute of Biomedical Research (IISA),Miguel Servet University Hospital, Zaragoza, Spain
| | - Teresa Macarulla
- Department of Medical Oncology, Vall d’Hebron Unveristy Hospital and Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Fernando Rivera
- University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Maria Teresa Cano
- IMIBIC, University of Córdoba, CIBERONC, Reina Sofía University Hospital, Córdoba, Spain
| | | | - Carles Pericay
- Sabadell University Hospital. Parc Tauli. Sabadell., Sabadell, Spain
| | | | - Laura Layos
- ICO. Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Begoña Graña
- A Coruña University Hospital. Instituto Investigación Biomédica INIBIC, A Coruña, Spain
| | - Vega Iranzo
- Valencia University Hospital, CIBERONC, Valencia University, Valencia, Spain
| | | | | | | | | | | | - Enrique Aranda
- IMIBIC, Córdoba University, CIBERONC. Reina Sofía University Hospital, Córdoba, Spain
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