Background Albumin-bound paclitaxel (nab-paclitaxel) is authorised to treat metastatic adenocarcinoma of the pancreas, as a first treatment in combination with gemcitabine.
Purpose To evaluate the management and effectiveness of nab-paclitaxel in pancreatic cancer.
Material and methods Observational and retrospective study included patients treated with nab-paclitaxel 125 mg/m2 days 1, 8 and 15, from May 2013 to December 2016. Variables collected: sex, age, treatment line, Karnofsky performance-status score (KPS), tumour staging at diagnosis (pTNM, AJCC 7th Edition) and previous chemotherapy. Clinical data was obtained from electronic history Cerner–Millenium® and oncology prescription software Farmis-Oncofarm®. Effectiveness variables: overall survival (OS) and progression-free survival (PFS), calculated by the Kaplan–Meier method and compared with log-rank test.
Results A total of 64 patients started nab-paclitaxel. The proportion of males was 50%. The median age was 64 years (44 to 75). Stage IV was diagnosed in 43.8%. Overall, 62.5% received it as a first line and 37.5% (24 patients) as >first line (off-label). Eighteen patients (75%) had previously been treated with combination therapy consisting of 5-FU/leucovorin plus oxaliplatin and irinotecan (FOLFIRINOX). Nab-paclitaxel associated with gemcitabine (GEM/nab-paclitaxel) was administered to 52 patients and nab-paclitaxel monotherapy (off-label) was administered to 12. The median OS (mOS) with GEM/nab-paclitaxel was 42.1 weeks (95% CI: 2.2 to 82.1: data for 51% of the patients was censored . Nab-paclitaxel monotherapy was compared with GEM/nab-paclitaxel and median PFS (mPFS) was similar in both groups (18.4 vs 19.3 weeks). The mPFS was different according to the treatment line: 35 weeks (95% CI: 23 to 47) and 11.7 (95% CI: 8. 4 to 15. 1) for 1 st line and >1 st line, respectively (p=0,001). The mPFS was 29. 4 weeks (95% CI: 14.1 to 40.7) for patients with KPS ≥80 versus 9.9 (95% CI: 8.4 to 11.3) with KPS ≤70, p=0.001. Patients were stratified according to age and staging: mPFS was higher for patients<65 years and stages<IV, but the difference was not significant.
Conclusion OS is higher than in the pivotal study (34 weeks) but it may not be analysable because more follow-up time would be needed. The results of PFS are optimised when nab-paclitaxel is used as a first line, according to the conditions of the marketing authorisation, and for patients with KPS ≥80.
No conflict of interest
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