Comparative effects of Folfirinox and Gemcitabine/nab-paclitaxel as first and second line chemotherapy for metastatic pancreatic cancer: single choice or sequence

Abstract

Background: Gemcitabine/nab‐paclitaxel and Folfirinox are standard of care of treatment of metastatic pancreatic cancer as first and second line in patients with good performance status or “fit”. Progression‐free survival shows similar data in both chemotherapy regimens. No data on the better treatment sequence is available. Methods: We have retrospectively analyzed 43 patients with histological diagnosis of metastatic pancreatic adenocarcinoma and an Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1. 23 (53,5%) and 20 (46,5%) of 43 patients received Folfirinox and Gemcitabine/Nab‐paclitaxel as first line chemotherapy respectively. Only 19 (44,1%) patients, after progression disease, started second line chemotherapy. 8 patients received Folfirinox, whereas 11 patients were treated with Gemcitabine Nab‐paclitaxel as second line regardless of prior chemotherapy. The sequence of chemotherapy Folfirinoxàgemcitabine/Nab‐paclitaxel versus Gemcitabine/Nab‐paclitaxelà Folfirinox was administered to 10 patients 5 for both, respectively. Results: Median Progression‐Free Survival was 5 months in the Folfirinox group as compared with 6 months in gemcitabine Nab‐paclitaxel group (hazard ratio for disease progression, 0.83; 95% CI, 0.34 to 1.32; P value = 0.95). No difference between the two groups were identified in first line. The median of progression‐free survival in second line was 2.5 months in the Folfirinox group and 4 months in the Gemcitabine/nabpaclitaxel. Hazard ratio for second disease progression was 0.62; 95% CI, 0.24 to 1.00; P value =0.03. The median overall survival in patients with the sequence of chemotherapy Folfirinoxàgemcitabine/Nab‐paclitaxel versus Gemcitabine/Nab‐paclitaxelà Folfirinox was retrospectively 8 months and 11 months. Conclusion: In this retrospective study, similar progression‐free survival we observed between Folfirinox group and Gemcitabine/Nab‐paclitaxel group in first line metastatic pancreatic cancer. These data need to be confirm in prospective randomized trial.