P-179 - Gemcitabine plus nab-Paclitaxel in metastatic or locally inoperable pancreatic cancer – a single center experience

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Pancreatic Cancer
Presenter U. Vogl
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors U. Vogl1, L. Vormittag1, T. Winkler2, A. Kafka1, M. Henry1, W. Schima3, A. Klaus4, J. Zacherl4, L. Öhler1
  • 1Oncology, Vienna/AT
  • 2St. Josef Hospital Vienna, Vienna/AT
  • 3Department of Radiology, Vienna/AT
  • 4Department of Surgery, Vienna/AT

Abstract

Introduction

Metastatic or inoperable pancreatic cancer has a dismal prognosis with a median survival time of less than a year. FOLFIRINOX (5-FU, calcium folinate, irinotecan, oxaliplatin) has improved the outcome as first-line therapy. The choice of second-line treatment for patients who have progressed on FOLFIRINOX and the first-line treatment for unfit patients is still unclear. The use of nab-paclitaxel in combination with gemcitabine is an efficient and safe option in this setting. We present the outcome and safety with the use of nab-paclitaxel and gemcitabine mainly in second-line treatment at our center.

Methods

Thirty-three patients (median age: 70 years, 61% male) with metastatic (64%) or locally advanced inoperable pancreatic cancer (36%) were treated with nab-paclitaxel and gemcitabine in second-line (88%) or first-line (24%). Two-thirds of patients presented with a good performance status (ECOG < 1). 18% received local radiation therapy. The application of gemcitabine (1000 mg/m2) and nab-paclitaxel (125 mg/m2) was modified to a 14 day schedule in two-thirds of patients due to the high incidence of grade 2 or 3 hematologic toxicities under the standard day 1,8,15 q28 schedule.

Results

The combination of nab-paclitaxel and gemcitabine is effective in patients with metastatic or locally advanced inoperable pancreatic cancer with manageable side effects especially when administered every two weeks. Adverse events were observed as follows: neutropenia (all grades: 33%, grade 3: 13%), thrombopenia (all grades: 47%, grade 3: 17%), alopecia (77%), nausea (grade 1 + 2: 33%), polyneuropathy (all grades: 30%, grade 3: 7%) and infection (7%). The median progression-free survival and overall survival time for patients treated with nab-paclitaxel and gemcitabine was 3 months (95% CI: 1.4 – 4.7) and 6.3 months (2.7-10 months), respectively. The overall survival time from the start of the first chemotherapy for metastatic or locally advanced disease was 15.4 months (95% CI: 9.2-21.6).

Conclusion

The combination of nab-paclitaxel and gemcitabine in second-line treatment after FOLFIRINOX for patients with good performance status can extend the median survival time to 15 months and should be viewed as the new standard for these patients. For elderly or FOLFIRINOX unfit patients this combination should be considered as first-line treatment