Abstract 345P
Background
FOLFIRINOX and gemcitabine plus nab-paclitaxel (GN) are the most commonly used regimens in advanced pancreatic ductal adenocarcinomas (PDACs). Due to limited comparative data between these regimens, this study aimed to compare their efficacy and tolerability through a matched-pair analysis.
Methods
We conducted a retrospective match-pair analysis of 100 patients with metastatic or locally advanced PDAC treated with either mFOLFIRINOX or GN between August 2019 to December 2022 at a tertiary care cancer institute in India. We used age and performance status as matching factors and compared progression-free survival (PFS), response rates, and grade 3/4 adverse events between the two groups.
Results
Out of 100 matched patients (51 in modified FOLFIRINOX and 49 in GN group), the median progression free survival (PFS) was 7 months (95% CI 5.178-8.822 months) in the modified FOLFIRINOX (mFOLFIRINOX) cohort and 6.28 months (95% CI 5.703-8.88 months) in the GN group. Patient characteristics: The study included 100 patients with advanced pancreatic cancer, who received either mFOLFIRINOX or GN as first-line chemotherapy. The patients were compared based on their age, sex, comorbidities, tumour site, disease stage, and CA 19-9 levels. Response rates: The overall response rate was 39%, with GN showing a higher response rate than mFOLFIRINOX (44% vs. 32%, P=0.026). The clinical benefit rate was 73%, with no significant difference between the two regimens (78% vs. 70%, P=0.097). Adverse events: The most common grade 3/4 adverse events were neutropenia (16%), anaemia (10%), infections (13%), and peripheral neuropathy (19%). mFOLFIRINOX was associated with more non-haematological toxicities such as nausea, vomiting, diarrhoea, mucositis, fatigue, and hand-foot syndrome, while GN caused more anaemia and neuropathy. Dose modifications were required in 33% of patients, more frequently in the GN group (38% vs. 26%, P=0.017).
Conclusions
In this analysis, both mFOLFIRINOX and GN had comparable survival outcomes for advanced PDAC, but mFOLFIRINOX had more non-myelosuppressive toxicities. Regimen selection should consider patient characteristics and preferences.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.