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Orlandi E, Citterio C, Anselmi E, Cavanna L, Vecchia S. FOLFIRINOX or Gemcitabine Plus Nab-paclitaxel as First Line Treatment in Pancreatic Cancer: A Real-World Comparison. Cancer Diagn Progn 2024; 4:165-171. [PMID: 38434919 PMCID: PMC10905291 DOI: 10.21873/cdp.10303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/15/2023] [Indexed: 03/05/2024]
Abstract
Background/Aim Advanced pancreatic cancer has a poor prognosis and a 5-year survival rate <5%; thus, treatment of patients with advanced unresectable or metastatic disease is challenging. Current guidelines recommend either gemcitabine plus nab-paclitaxel (GnP) or FOLFIRINOX (FOL) as first-line treatment. Data on both efficacy and toxicity of FOL versus GnP in metastatic cancer are limited. This study aimed to compare the two chemotherapy regimens in terms of efficacy and toxicity in a real-world setting. Patients and Methods This retrospective propensity score matching study reviewed the medical records of 123 consecutive patients with advanced or metastatic pancreatic cancer who received either GnP or FOL between March 2013 and January 2019 in Guglielmo da Saliceto Hospital, Piacenza. Results Fifty patients (40.65%) received FOL, administered in an attenuated dose, and seventy-three patients (59.35%) received GnP. After a propensity matching score, 100 patients were retrospectively evaluated. In the final matched cohort, there was no difference in neoadjuvant therapy, radiotherapy, and surgery performed before the first-line therapy between the two groups. Progression-free survival and overall survival were comparable between the two groups and no difference was found in the percentage of toxicity. Conclusion There was no difference in outcomes between patients who received FOL and those who received GnP. Unexpectedly, no greater FOL-related toxicity was found, probably due to the dose reduction.
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Affiliation(s)
- Elena Orlandi
- Oncology and Hematology Department, AUSL Piacenza Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Chiara Citterio
- Oncology and Hematology Department, AUSL Piacenza Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Elisa Anselmi
- Oncology and Hematology Department, AUSL Piacenza Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Luigi Cavanna
- Oncology and Hematology Department, AUSL Piacenza Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Stefano Vecchia
- Pharmacy Department, AUSL Piacenza Guglielmo da Saliceto Hospital, Piacenza, Italy
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Catalano M, Roviello G, Aprile G, Ramello M, Conca R, Petrioli R, Perrone G, Ianza A, Mini E. Prognostic value of alkaline phosphatase and gamma-glutamyl transferase in patients with metastatic pancreatic cancer. Future Oncol 2023. [PMID: 37232154 DOI: 10.2217/fon-2023-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Background: Pancreatic cancer (PC) is one of the most lethal malignancies worldwide. This study evaluated the prognostic role of serum alanine phosphatase (ALP) and gamma-glutamyl-transferase (GGT) in metastatic PC patients. Materials & methods: 153 patients with metastatic PC receiving first-line treatment with nab-paclitaxel/gemcitabine were retrospectively enrolled in a multicenter study and stratified according to ALP (≤ or >260 U/l) and GGT (≤ or >45.5 U/l) levels. Results: Improved overall survival was recorded in patients with GGT levels ≤45.5 U/l (p < 0.05). In patients with liver metastasis, overall survival was significantly lower in patients with high ALP (p = 0.01) and GGT (p = 0.02). Conclusion: High levels of ALP and GGT were related to a poor prognosis in PC patients with liver metastasis receiving nab-paclitaxel/gemcitabine.
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Affiliation(s)
- Martina Catalano
- Department of Health Sciences, University of Florence, 50139, Florence, Italy
| | | | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, AULSS8 Berica, Vicenza, Italy
| | - Monica Ramello
- Oncology Unit, Department of Medical, Surgical, & Health Sciences, University of Trieste, Piazza Ospitale, Trieste, Italy
| | - Raffaele Conca
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, 85028, Rionero, Vulture (PZ), Italy
| | - Roberto Petrioli
- Department of Medicine, Surgery & Neurosciences, Medical Oncology Unit, University of Siena, 53100, Siena, Italy
| | - Gabriele Perrone
- Department of Health Sciences, University of Florence, 50139, Florence, Italy
| | - Anna Ianza
- Oncology Unit, Department of Medical, Surgical, & Health Sciences, University of Trieste, Piazza Ospitale, Trieste, Italy
| | - Enrico Mini
- Department of Health Sciences, University of Florence, 50139, Florence, Italy
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Servetto A, Santaniello A, Napolitano F, Foschini F, Marciano R, Cascetta P, Amato AR, Augurio MR, Maresca L, De Placido P, De Placido S, Formisano L, Bianco R. FOLFIRINOX or nab-paclitaxel plus gemcitabine in metastatic pancreatic adenocarcinoma: an observational study. Future Oncol 2022; 18:2643-2653. [PMID: 35608115 DOI: 10.2217/fon-2021-1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Comparison of first-line FOLFIRINOX (FFN) and nab-paclitaxel plus gemcitabine (NabGem) in patients with metastatic pancreatic ductal adenocarcinoma. Patients & methods: The authors analyzed data from 160 patients with metastatic pancreatic adenocarcinoma receiving first-line FFN (n = 43) or NabGem (n = 117). Results: FFN and NabGem were similar in median progression-free survival (24.43 vs 26.28 weeks; hazard ratio [HR]: 0.88) and medial overall survival (47.43 vs 42.86 weeks; HR: 0.90). Of the 43 patients receiving FFN, 26 (60.4%) were treated with second-line NabGem; 14/117 (12.0%) patients receiving NabGem received second-line FFN (p < 0.0001). In the FFN → NabGem and NabGem → FFN groups, median overall survival was 51.2 and 71.6 weeks (HR: 0.69; p = 0.15). In patients receiving NabGem, second-line FFN, compared with FOLFOX/CAPOX or FOLFIRI, improved median progression-free survival 2 (25.6 vs 12.1 weeks; HR: 0.47; p = 0.0067) and median overall survival 2 (39.0 vs 19.14 weeks; HR: 0.49; p = 0.032). Conclusion: First-line FFN and NabGem promote similar clinical outcomes. Second-line FFN should be considered after NabGem.
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Affiliation(s)
- Alberto Servetto
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Antonio Santaniello
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Fabiana Napolitano
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Francesca Foschini
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Roberta Marciano
- Azienda Ospedaliera Universitaria San Giovanni di Dio Ruggi d'Aragona, Salerno, 84125, Italy
| | - Priscilla Cascetta
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Anna Rita Amato
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Maria Rosaria Augurio
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Lucia Maresca
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Pietro De Placido
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Sabino De Placido
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Luigi Formisano
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Roberto Bianco
- Department of Clinical Medicine & Surgery, University of Naples Federico II, Naples, 80131, Italy
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Servetto A, Santaniello A, Napolitano F, Foschini F, Marciano R, Mozzillo E, Cascetta P, Amato AR, Augurio MR, Maresca L, De Placido P, De Placido S, Formisano L, Bianco R. Use of FOLFIRINOX or Nab-Paclitaxel Plus Gemcitabine for the Treatment of Locally Advanced Pancreatic Adenocarcinoma: A Single Institution Observational Study. Cancers (Basel) 2021; 13:4939. [PMID: 34638422 DOI: 10.3390/cancers13194939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary We performed a retrospective analysis to evaluate the effect of treatment with FOLFIRINOX (FFN) or Nab-paclitaxel plus gemcitabine (GemNab) in patients with locally advanced (LA) pancreatic adenocarcinoma (PDAC). Forty-eight percent of patients treated with FFN became eligible for radical resection, and twenty-two percent of patients receiving GemNab underwent surgery after neoadjuvant treatment. FFN treatment was associated with a better overall survival, compared with GemNab (mOS 85.1 vs. 54.3 weeks, FFN and GemNab, respectively; HR = 0.54; p = 0.0109). We found different toxicity profiles between the two chemotherapy regimens. Future randomized clinical trials are mandatory to clarify the best treatment in patients with LA PDAC. Abstract Patients with locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) do not present distant metastases but are not eligible for surgery upfront. Chemotherapy regimens, such as FOLFIRINOX (FFN) or nab-paclitaxel plus gemcitabine (GemNab) in combination with loco-regional treatments are generally used in this setting. However, the best treatment choice is unknown. We retrospectively analyzed the information of 225 patients with stage II–III PDAC treated at our institution between October 2011 and December 2020. A total of 94 patients with LA PDAC who are non-eligible for surgery upfront received neoadjuvant FFN or GemNab. Of the 67 patients receiving FFN, 28 (41.8%) underwent surgery after neoadjuvant therapy. Of the 27 patients treated with GemNab, 6 (22.2%) became eligible for resection. The median overall survival (OS) was 85.1 weeks and 54.3 weeks in the FFN and GemNab groups, respectively (HR = 0.54, p = 0.0109). The median OS was 189.7 weeks and 76.4 weeks in the resected and unresected cohorts, respectively (HR = 0.25, p < 0.0001). Neutropenia (37.3%), anemia (6.0%), and diarrhea (6.0%) in the FFN group and neutropenia (22.2%) and thrombocytopenia (18.5%) in the GemNab groups were the most frequent grade 3–4 side effects. Higher rates of thrombocytosis (p < 0.0001) and peripheral edema (p < 0.0001) were observed in the GemNab group. Our results suggest that the use of FFN is associated with more favorable clinical outcomes than GemNab for patients with LA PDAC. Future randomized and controlled clinical trials are needed to further elucidate the role of these regimens and loco-regional treatments in this setting.
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Quan Q, Wang Y, Wang F, Zhang D, Chen X, He W, Zhang B, Guo G. Real World First-Line Treatments and Outcomes of Nab-Paclitaxel Plus Gemcitabine, mFOLFIRINOX and GEMOX in Unresectable Pancreatic Cancer from a Chinese Single Institution. ACTA ACUST UNITED AC 2020; 28:209-19. [PMID: 33704188 DOI: 10.3390/curroncol28010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 12/24/2022]
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.
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Petrillo A, Pappalardo A, Calabrese F, Tirino G, Pompella L, Ventriglia J, Laterza MM, Caterino M, Sforza V, Iranzo V, Biglietto M, Orditura M, Ciardiello F, Conzo G, Molino C, De Vita F. First line nab-paclitaxel plus gemcitabine in elderly metastatic pancreatic patients: a good choice beyond age. J Gastrointest Oncol 2019; 10:910-917. [PMID: 31602329 DOI: 10.21037/jgo.2019.06.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Nab-paclitaxel plus gemcitabine represents one of the standard regimens for first line treatment of metastatic pancreatic cancer (mPC). Few data are available on nab-paclitaxel plus gemcitabine in geriatric population. Our study aims to show whether this schedule can be feasible in the elderly as first-line treatment for mPC. Methods We retrospectively analyzed the data of 64 mPC patients (≥65 years old) treated according to the MPACT schedule. Results Median age was 69.5 years (range, 65-80 years); after a median of 5 cycles administered (range, 1-12), the most common adverse events (AEs) were grade 2 alopecia (46.9%), anemia (17.2%) and hypertransaminasemia (10.9%); all grades neutropenia occurred in 20.3% of pts. Global incidence of grade 3 and 4 toxicities were 26.5% and 0%, respectively, and no patients stopped treatment due to unacceptable toxicity. Stable disease (SD) was observed in 31.2% of patients, with a disease control rate (DCR) and overall response rate of 57.8% and 26.6%, respectively. After a median follow-up of 18 months, median progression free survival (PFS) was 8 months (95% CI: 6.3-9.6) and median OS was 12.0 months (95% CI: 8.4-15.6). The univariate analysis for overall survival (OS) showed that only ECOG performance status was an independent prognostic factor for survival. Conclusions Nab-paclitaxel plus gemcitabine schedule is feasible and effective in the "daily clinical practice" geriatric population.
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Affiliation(s)
- Angelica Petrillo
- Division of Medical Oncology, Department of Precision Medicine, University of study of Campania "L. Vanvitelli", Napoli, Italy
| | - Annalisa Pappalardo
- Division of Medical Oncology, Department of Precision Medicine, University of study of Campania "L. Vanvitelli", Napoli, Italy
| | | | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, University of study of Campania "L. Vanvitelli", Napoli, Italy
| | - Luca Pompella
- Division of Medical Oncology, Department of Precision Medicine, University of study of Campania "L. Vanvitelli", Napoli, Italy
| | - Jole Ventriglia
- Division of Medical Oncology, Department of Precision Medicine, University of study of Campania "L. Vanvitelli", Napoli, Italy
| | - Maria Maddalena Laterza
- Division of Medical Oncology, Department of Precision Medicine, University of study of Campania "L. Vanvitelli", Napoli, Italy
| | - Marianna Caterino
- Division of Medical Oncology, Department of Precision Medicine, University of study of Campania "L. Vanvitelli", Napoli, Italy
| | - Vincenzo Sforza
- Medical Oncology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Vega Iranzo
- Medical Oncology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Maria Biglietto
- Division of Medical Oncology, AORN, "A Cardarelli", Napoli, Italy
| | - Michele Orditura
- Division of Medical Oncology, Department of Precision Medicine, University of study of Campania "L. Vanvitelli", Napoli, Italy
| | - Fortunato Ciardiello
- Division of Medical Oncology, Department of Precision Medicine, University of study of Campania "L. Vanvitelli", Napoli, Italy
| | - Giovanni Conzo
- Department of Cardiothoracic Sciences, University of study of Campania "L. Vanvitelli", Naples, Italy
| | - Carlo Molino
- Division of General Surgery, AORN, "A. Cardarelli", Napoli, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of study of Campania "L. Vanvitelli", Napoli, Italy
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Zhang Y, Xu J, Hua J, Liu J, Liang C, Meng Q, Ni Q, Shi S, Yu X. Nab-paclitaxel plus gemcitabine as first-line treatment for advanced pancreatic cancer: a systematic review and meta-analysis. J Cancer 2019; 10:4420-4429. [PMID: 31413762 PMCID: PMC6691695 DOI: 10.7150/jca.29898] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 09/12/2018] [Accepted: 06/19/2019] [Indexed: 01/05/2023] Open
Abstract
To evaluate the effectiveness of nab-paclitaxel plus gemcitabine (NG) as a first-line treatment for advanced pancreatic cancer. A meta-analysis was performed to assess the impact on the objective response rate (ORR), survival rate and grade 3/4 adverse events. Of the 2,056 patients included from 26 studies, the median overall survival ranged from 6.9 months to 24.7 months, with a 1-year survival rate of 45.2% (95%CI: 35.8% -54.5%). The 6-month progression-free survival rate was 41.0% (95%CI: 30.5% - 51.4%), and the ORR was 31.6% (95%CI: 26.7% - 36.6%). Fifty locally advanced pancreatic cancer (LAPC) patients underwent surgery and had an R0 resection rate of 52.0%. No death was caused by toxicity, and 1,329 grade 3/4 adverse events were reported in 1,353 patients. NG has been proven to reduce tumours with an acceptable toxicity profile in metastatic pancreatic cancer. This analysis further demonstrates the efficacy and safety of NG for treating LAPC.
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Affiliation(s)
- Yiyin Zhang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai 200032, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
- Shanghai Pancreatic Cancer Institute, No. 270 Dong'An Road, Shanghai 200032, PR China
- Pancreatic Cancer Institute, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
| | - Jin Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai 200032, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
- Shanghai Pancreatic Cancer Institute, No. 270 Dong'An Road, Shanghai 200032, PR China
- Pancreatic Cancer Institute, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
| | - Jie Hua
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai 200032, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
- Shanghai Pancreatic Cancer Institute, No. 270 Dong'An Road, Shanghai 200032, PR China
- Pancreatic Cancer Institute, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
| | - Jiang Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai 200032, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
- Shanghai Pancreatic Cancer Institute, No. 270 Dong'An Road, Shanghai 200032, PR China
- Pancreatic Cancer Institute, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
| | - Chen Liang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai 200032, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
- Shanghai Pancreatic Cancer Institute, No. 270 Dong'An Road, Shanghai 200032, PR China
- Pancreatic Cancer Institute, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
| | - Qingcai Meng
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai 200032, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
- Shanghai Pancreatic Cancer Institute, No. 270 Dong'An Road, Shanghai 200032, PR China
- Pancreatic Cancer Institute, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
| | - Quanxing Ni
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai 200032, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
- Shanghai Pancreatic Cancer Institute, No. 270 Dong'An Road, Shanghai 200032, PR China
- Pancreatic Cancer Institute, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
| | - Si Shi
- Shanghai Pancreatic Cancer Institute, No. 270 Dong'An Road, Shanghai 200032, PR China
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong'An Road, Shanghai 200032, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
- Shanghai Pancreatic Cancer Institute, No. 270 Dong'An Road, Shanghai 200032, PR China
- Pancreatic Cancer Institute, Fudan University, No. 270 Dong'An Road, Shanghai 200032, PR China
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Martín AJM, Alfonso PG, Rupérez AB, Jiménez MM. Nab-paclitaxel plus gemcitabine as first-line palliative chemotherapy in a patient with metastatic pancreatic cancer with Eastern Cooperative Oncology Group performance status of 2. Oncol Lett 2016; 12:727-730. [PMID: 27347207 DOI: 10.3892/ol.2016.4667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/24/2016] [Indexed: 12/12/2022] Open
Abstract
Metastatic pancreatic cancer (PC) has been associated with a considerably poor prognosis. Due to its toxicity, first-line combination chemotherapy is limited to patients with a good performance status (PS). Previously nab-paclitaxel plus gemcitabine has been demonstrated to improve the overall survival rate in patients with advanced pancreatic cancer with a good PS. The present study reports a case of a patient with metastatic PC with a poor PS (Eastern Cooperative Oncology Group 2) and a complex set of comorbidities treated with nab-paclitaxel plus gemcitabine as a first-line palliative therapy. Adjusted doses of nab-paclitaxel plus gemcitabine reached a favourable clinical, radiological and biochemical response in the present patient, which increased the quality of life for the patient. Eventually, the patient succumbed to acute cholangitis. Based on the results of the present study, nab-paclitaxel plus gemcitabine appears to be a favourable treatment as first-line palliative chemotherapy for patients with metastatic PC, comorbidities and poor PS.
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Affiliation(s)
- Andrés J Muñoz Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
| | - Pilar García Alfonso
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
| | - Ana B Rupérez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
| | - Miguel Martín Jiménez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
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Portal A, Pernot S, Tougeron D, Arbaud C, Bidault AT, de la Fouchardière C, Hammel P, Lecomte T, Dréanic J, Coriat R, Bachet JB, Dubreuil O, Marthey L, Dahan L, Tchoundjeu B, Locher C, Lepère C, Bonnetain F, Taieb J. Nab-paclitaxel plus gemcitabine for metastatic pancreatic adenocarcinoma after Folfirinox failure: an AGEO prospective multicentre cohort. Br J Cancer 2015; 113:989-95. [PMID: 26372701 PMCID: PMC4651133 DOI: 10.1038/bjc.2015.328] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/07/2015] [Accepted: 08/13/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is currently no standard second-line treatment for metastatic pancreatic adenocarcinoma (MPA), and progression-free survival is consistently <4 months in this setting. The aim of this study was to evaluate the efficacy and tolerability of Nab-paclitaxel plus gemcitabine (A+G) after Folfirinox failure in MPA. METHODS From February 2013 to July 2014, all consecutive patients treated with A+G for histologically proven MPA after Folfirinox failure were prospectively enrolled in 12 French centres. A+G was delivered as described in the MPACT trial, until disease progression, patient refusal or unacceptable toxicity. RESULTS Fifty-seven patients were treated with Nab-paclitaxel plus gemcitabine, for a median of 4 cycles (range 1-12). The disease control rate was 58%, with a 17.5% objective response rate. Median overall survival (OS) was 8.8 months (95% CI: 6.2-9.7) and median progression-free survival was 5.1 months (95% CI: 3.2-6.2). Since the start of first-line chemotherapy, median OS was 18 months (95% CI: 16-21). No toxic deaths occurred. Grade 3-4 toxicities were reported in 40% of patients, consisting of neutropenia (12.5%), neurotoxicity (12.5%), asthenia (9%) and thrombocytopenia (6.5%). CONCLUSIONS A+G seems to be effective, with a manageable toxicity profile, after Folfirinox failure in patients with MPA.
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Affiliation(s)
- Alix Portal
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris, France
| | - Simon Pernot
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris, France
| | - David Tougeron
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France
| | - Claire Arbaud
- Methodological and Quality of Life Unit in Oncology, Quality of Life and Cancer Clinical Research Platform, Besançon University Hospital, Besançon, France
| | - Anne Thirot Bidault
- Department of Gastroenterology, Kremlin Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Sud University, Le Kremlin Bicêtre, France
| | | | - Pascal Hammel
- Department of Digestive Oncology, Hospital Beaujon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Denis Diderot University, Clichy, France
| | - Thierry Lecomte
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Tours, UMR CNRS 7192, François-Rabelais University, Tours, France
| | - Johann Dréanic
- Gastroenterology and Endoscopy Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Romain Coriat
- Gastroenterology and Endoscopy Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Jean-Baptiste Bachet
- Department of Gastroenterology, La Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, UPMC University Paris 06, Paris, France
| | - Olivier Dubreuil
- Department of Gastroenterology, La Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, UPMC University Paris 06, Paris, France
| | - Lysiane Marthey
- Department of Hepatogastroenterology and Nutrition, Antoine-Béclère Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), DHU Hepatinov, Clamart, France
| | - Laetitia Dahan
- Department of Gastroenterology, University Hospital La Timone, Aix-Marseille University, Marseille, France
| | - Belinda Tchoundjeu
- Department of Gastroenterology and Digestive Oncology, Orleans Regional Hospital (CHRO), Orleans, France
| | | | - Céline Lepère
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris, France
| | - Franck Bonnetain
- Methodological and Quality of Life Unit in Oncology, Quality of Life and Cancer Clinical Research Platform, Besançon University Hospital, Besançon, France
| | - Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris, France
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