Nab-Paclitaxel plus Gemcitabine (AG) and FOLFIRINOX (FFX) have been established as standard first-line treatment in metastatic pancreatic cancer (mPC) based on the superior efficacy compared to gemcitabine monotherapy. Although FFX is recommended for patients with relatively young age and good performance status (PS), there is lack of data for optimal choice between these two regimens. We performed retrospective analysis comparing the efficacies and safety of AG and FFX in mPC patients as first line therapy.
A total of 308 patients with mPC who were treated with AG (n = 149) or FFX (n = 159) as first-line treatment between January 2013 and December 2016 at Asan Medical Center, Seoul, Korea were included. Treatment outcomes including survivals, response rates and toxicities of each regimen were evaluated.
Patients treated with AG were older (62 vs. 60 years, p = 0.02) and they had higher Charlson Comorbidity Index (CCI) score (≥9, 46.3% vs. 32.7%, p = 0.02). There were no significant differences between the two groups in terms of other baseline characteristics. The response rates (34% vs 34%, p = 0.88) and median progression-free survival (PFS) (6.8 vs 5.1 months, p = 0.19) were comparable, but median overall survival (OS) was significantly better with AG (11.4 vs 9.6 months; p = 0.002). In subgroup analyses, PFS with AG was longer in patients with age ≥ 65 years, peritoneal metastasis, and higher CCI than that with FFX. While grade 3-4 peripheral neuropathy was more common in the AG group (10% vs 3%), grade 3 nausea was more frequent in the FFX group (2% vs 17%); granulocyte colony-stimulating factor was required only in the FFX group (n = 27, 18%).
AG was well tolerated and showed comparable efficacy outcomes with FFX. Of note, AG might be preferentially considered as the first-line treatment in mPC patients with peritoneal metastasis, comorbid medical conditions or old age. As both regimens are feasible as first-line treatment for mPC, further investigations are needed for the personalized uses of these regimens.
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All authors have declared no conflicts of interest.