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Clinical outcomes of FOLFIRINOX and gemcitabine–nab paclitaxel for metastatic pancreatic cancer in the real world setting

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Abstract

Background/objectives

The incidence of pancreatic cancer is increasing in developed countries. The incorporation of new therapies, to the first-line treatment of patients with good performance status led to better survival in clinical trials. However, there is a wide variability in their use and some concerns about the treatment of elderly patients who were not included in the clinical trials.

Methods

This is a retrospective multicenter study. Data from consecutive patients diagnosed with metastatic pancreatic cancer (mPC) treated with FOLFIRINOX (FFX) or gemcitabine plus nab-paclitaxel (GnP) were analysed to evaluate efficacy (overall survival—OS) and toxicity.

Results

A total of 119 patients were included. 49.6% were treated with FFX and 50.4% with GNP in first-line. The median OS was 12 months with no statistically significant differences between both regimens (12.7 m for FFX vs 10.2 m for GnP). Elevated Ca 19.9 levels and neutrophil–lymphocyte ratio (NLR) increased the risk of death. Patients who received both regimens in first/second line had a median OS longer than 15 months whichever the sequence. 32 patients (27%) were older than 70-y. 54% patients received a second-line treatment, 56% in the FFX group and 44% in the GnP group. The median OS for patients older than 70 was 9.5 m versus 12.3 m for patients younger than 70. Progression of the disease was the cause of death in 67.6% of the patients.

Conclusions

In our setting, the use of FFX and GnP for treating mPC is quite similar, but superiority could not be demonstrated for any of the schemes in the first line. OS was determined by basal levels of Ca 19.9 and NLR. Patients receiving both regimens in first/second line whichever the sequence, exhibited the best survival rates. In our series, elderly patients had poorer survival rates.

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Authors and Affiliations

  1. Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain

    F. Franco & A. Ruiz-Casado

  2. Department of Medical Oncology, Fundación Hospital Alcorcón, Alcorcón, Spain

    J. C. Camara

  3. Department of Medical Oncology, Fundación Jiménez Díaz, Madrid, Spain

    J. I. Martín-Valadés & A. León

  4. Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain

    A. López-Alfonso & M. Pérez

  5. Department of Medical Oncology, Hospital Universitario de Móstoles, Móstoles, Spain

    D. Marrupe

  6. Department of Medical Oncology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain

    D. Gutiérrez-Abad & I. Juez

  7. Department of Medical Oncology, Hospital Universitario Rey Juan Carlos, Móstoles, Spain

    B. Martínez-Amores

  8. Department of Biostatistics, Hospital Universitario Puerta de Hierro, Majadahonda, Spain

    A. Royuela

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  1. F. Franco
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Correspondence to F. Franco.

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The authors declare that they have no conflict of interests.

Ethical approval

The Ethics Committee at the Hospital Universitario Puerta de Hierro-Majadahonda approved the study protocol. According to the Spanish Law, the Agencia Española de Medicamentos y Productos Sanitarios classified the study as an EPA-OD (retrospective cohort study).

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For retrospective studies informed consent is not required.

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Franco, F., Camara, J.C., Martín-Valadés, J.I. et al. Clinical outcomes of FOLFIRINOX and gemcitabine–nab paclitaxel for metastatic pancreatic cancer in the real world setting. Clin Transl Oncol 23, 812–819 (2021). https://doi.org/10.1007/s12094-020-02473-w

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