Gemcitabine plus nab-paclitaxel versus modified FOLFIRINOX as first line chemotherapy in metastatic pancreatic cancer: A comparison of toxicity and survival

Abstract

Introduction: Gemcitabine plus nab-paclitaxel and modified FOLFIRINOX have been established as first line chemotherapy in metastatic pancreatic cancer, but there is no conclusive data on their comparison. The aim of our study is to evaluate survival and toxicity profile of metastatic pancreatic cancer patients treated with these therapies. Method(s): Retrospective review of 85 metastatic PC diagnosed between January 2014 and January 2018 at two tertiary hospitals. Differences in treatment-related toxicity were assessed by the Chi-square test, progression-free survival (PFS) and overall survival (OS) with the log-rank test. Result(s): 46 patients were included: 25 Gemcitabine plus Nab-Paclitaxel and 21 received modified FOLFIRINOX. Median age was 63 years. Demographic and baseline characteristics were similar as follows (gemcitabine plus nab-paclitaxel/mFOLFIRINOX): Gender (male): 72%/71%, comorbidities: 16%/14%, liver metastasis: 72%/63%, jaundice that required stent insertion: 32%/48% and thromboembolic events: 56%/62%. The population of elderly patients (> 70y) was similar between both cohorts (36% vs. 42%, p=0.2) but, 48% of patients treated with gemcitabine plus nab-paclitaxel showed ECOG PS>1 compared to 4% of patients treated with mFOLFIRINOX (p=0.01). Similar toxicity profile between both treatments was observed (36% vs 28%, p=0.67). Incidence of grade 4 neutropenia was similar in both cohorts (12% vs 10%, p=0.7), probably due to an increased use of G-CSF in patients receiving mFOLFIRINOX. Also, peripheral neuropathy (5% vs 7%, p=0.8) and diarrhea (3% vs 2.1%, p=0.6) were similar between groups. No differences were observed in median PFS of mFOLFIRINOX compared to gemcitabine plus nab-paclitaxel (8 months vs 4 months, p=0.26). However, median OS was significantly longer in patients treated with mFOLFIRINOX (14 months vs 7 months, p=0.02). Conclusion(s): Metastatic pancreatic cancer patients treated with mFOLFIRINOX showed increased survival compared to gemcitabine plus nab-paclitaxel, with a similar toxicity profile. These results raise the issue of appropriately selecting patients with poor ECOG PS who can benefit from gemcitabine plus nab-paclitaxel for an adequate control of disease.