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Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

4996 - NAPOLI-1 phase 3 trial outcomes by prior surgery, and disease stage, in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC)


21 Oct 2018


Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology


Surgical Oncology

Tumour Site

Pancreatic Adenocarcinoma


Teresa Macarulla Mercade


Annals of Oncology (2018) 29 (suppl_8): viii205-viii270. 10.1093/annonc/mdy282


T. Macarulla Mercade1, G. Bodoky2, J. Siveke3, K. Lee4, J. Chen5, B. Mirakhur6, A. Dean7, L. Chen8, F. de Jong9

Author affiliations

  • 1 Medical Oncology, Vall d`Hebron Institute of Oncology (VHIO)-Cellex Center, 08035 - Barcelona/ES
  • 2 Oncology, St. László Hospital, 1097 - Budapest/HU
  • 3 Medical Oncology, University Hospital Essen West German Cancer Center, 45122 - Essen/DE
  • 4 Medical Oncology, Seoul National University Hospital, Seoul/KR
  • 5 Biostatistics, Shire plc, Cambridge/US
  • 6 Medical Affairs, Ipsen Biopharmaceuticals, Inc., Basking Ridge/US
  • 7 Medical Oncology, Saint John of God Hospital Subiaco, 6008 - Subiaco/AU
  • 8 National Institute Of Cancer Research, National Health Research Institutes, Tainan/TW
  • 9 Global Medical Affairs Oncology, Shire International GmbH, Zug/CH


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Abstract 4996


The NAPOLI-1 phase 3 trial (NCT01494506) reported significantly increased median OS with nal-IRI+5-FU/LV vs 5-FU/LV (6.1 mo vs 4.2 mo; HR = 0.67; p = 0.012) in mPDAC patients who progressed after gemcitabine-based therapy. We report subgroup analysis outcomes in NAPOLI-1 patients who had undergone prior surgery and by disease stage at diagnosis.


This post-hoc analysis investigated outcomes with or without prior surgery, and by disease stage at diagnosis (stage IIA, IIB, or III, vs IV). P values are descriptive.


In the NAPOLI-1 trial, OS and PFS were increased in ITT patients who had undergone prior surgery compared to those who did not (Table). In patients with prior surgery receiving nal-IRI+5-FU/LV (n = 40), OS and PFS were increased vs 5-FU/LV (n = 43) (HR = 0.84 and 0.72). Patients without prior surgery had significantly increased OS and PFS with nal-IRI+5-FU/LV (n = 77) vs 5-FU/LV (n = 76) (HR = 0.56, p = 0.003 and HR = 0.47, p < 0.001). OS was significantly increased in ITT patients with disease stages IIA (n = 36, HR = 0.59, p = 0.013), IIB (n = 77, 0.54, <0.001), and III (n = 75, 0.57, <0.001) vs stage IV (n = 213). A consistent OS increase was also seen in patients treated with nal-IRI+5-FU/LV: stage IIA (HR = 0.63, ns) stage IIB (HR = 0.50, p = 0.024) and stage III (HR = 0.43, p = 0.021) vs stage IV.Table: 733P

Prior surgery
All ITTYes*No*
P value<0.0010.5470.003
P value0.1290.217<0.001
Disease stage at diagnosis
Stage IIAStage IIB
n = 36n = 6n = 9n = 77n = 26n = 22
P value0.0130.3900.070<0.0010.0240.012
Stage IIIStage IV
n = 75n = 21n = 19n = 213n = 61n = 62
P value<0.0010.0210.039

Comparing treatments;

vs Stage IV


OS and PFS were increased in ITT patients who had undergone surgery prior to trial inclusion. Patients treated with nal-IRI+5-FU/LV showed a consistent increase in OS and PFS vs 5-FU/LV. ITT patients with stages IIA, IIB, and III had significantly improved OS vs those with stage IV disease. Treatment with nal-IRI+5-FU/LV showed a survival benefit across disease stages IIA, IIB, and III, vs stage IV. Limited patient numbers should be taken into consideration when interpreting these findings.

Clinical trial identification


Legal entity responsible for the study

Merrimack Pharmaceuticals.


The analysis was funded by Shire, the study was funded by Merrimack Pharmaceuticals.

Editorial Acknowledgement

Medical writing support for the preparation of this abstract was provided by Physicians World Europe GmbH, Mannheim, Germany, with financial support from Shire (previously Baxalta), Zug, Switzerland.


G. Bodoky: Consulting, Advisory role: Bayer, Ipsen, Janssen, Lilly, Novartis, Pfizer, Roche; Support for travel, accommodation and expenses: Janssen, Lilly, Novartis, Pfizer, Roche. J. Siveke: Consulting, Advisory role: Merrimack Pharmaceuticals, Baxalta (now part of Shire), Celgene, Lilly; Research funding: Celgene, Bristol-Myers Squibb, 4SC, Novartis, Boehringer Ingelheim; Travel, accommodation, expenses: Roche, Celgene, Shire. J. Chen, F. de Jong: Employee, Stockholder: Shire. B. Mirakhur: Employee: Ipsen, Stockholder: Ipsen, GlaxoSmithKline. A. Dean: Honoraria: Specialised Therapeutics Australia; Consultant/Advisor: Baxalta (now part of Shire), Celgene. L-T. Chen: Honoraria, Consultant, Advisor: Bristol-Myers Squibb, Ono Pharmaceutical, Lilly, MSD, PharmaEngine, Merrimack Pharmaceuticals, TTY Biopharm, SynCoreBio, Five Prime, Novartis; Patent: Hunilife Technology; Research funding: Novartis, GlaxoSmithKline, Merck Serono, TTY Biopharm, Polaris, SyncoreBio, Pfizer, Celgene. All other authors have declared no conflicts of interest.

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