Abstract 377P
Background
Half of the patients diagnosed with mPC are over 65 years of age. Considering the difficulty of prescribing the GemNab regimen due to the low availability of nab-paclitaxel, mFOLFIRINOX is the regimen of choice as the 1st line of treatment. Given the toxicity of this regimen, the question of selecting groups of patients who will receive the maximum benefit from this regimen is one of the main challenges.
Methods
We analyzed 95 patients with mPC over 65 years (median age 68 years) of age who received first-line chemotherapy with mFOLFIRINOX (n=51; 65-79 years; median - 68) or gemcitabine monotherapy (n=44; 65-86 years; median - 69). Univariate and multivariate analyzes were performed.
Results
Three independent prognostic factors were identified: ECOG status, location of the primary tumor, CA19-9 level. 1) Functional status of the patient before starting first-line chemotherapy: ECOG 2-3 – 1 point 2) Initial level of CA19-9: CA19-9 ≥ 2500 - 1 point 3) Localization of the primary tumor: Head of the pancreas – 0 points Other localization of the primary tumor – 2 points Based on the results obtained, a prognostic model was created. Three prognostic groups were formed: 1) group of favorable prognosis – 0 points 2) intermediate group – 1-2 points 3) poor prognosis group ≥2 points There were no statistically significant differences in the distribution of prognostic groups (p=0.33). The median OS in patients with a favorable prognosis in the mFOLFIRINOX group was 12.5 months, in the group with gemcitabine monotherapy - 7.8 months (p = 0.77). In patients with an intermediate prognostic group, during triple chemotherapy, mOS was significantly higher - 12 months, gemcitabine - 5.5 months (p = 0.018). The mFOLFIRINOX regimen increased survival in the poor prognosis group, with an mOS of 8.9 months compared with 4.4 months in the gemcitabine group, but p=0.08.
Conclusions
According to the results of our study, we observe that patients in the intermediate prognostic group showed a statistically significant benefit from the administration of mFOLFIRINOX. It is likely that in the poor prognosis group, with a larger number of patients, a significant difference would have been achieved. However, for patients with a favorable prognosis, there is no need to escalate the regimen.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.