Background and importance Pancreatic cancer (PC) is a highly lethal malignancy although palliative systemic chemotherapy can improve disease-related symptoms and prolong survival. In our hospital the most used treatment regimens for this pathology are nabpaclitaxel plus gemcitabine (GemNab) and FOLFIRINOX. There are no studies that directly compare the two schemes, making the choice empirical.
Aim and objectives To assess the effectiveness and safety of GemNab versus FOLFIRINOX in metastatic PC.
Material and methods A descriptive retrospective study from January 2016 to September 2021 was conducted. Variables collected were age, sex, Eastern Cooperative Oncology Group (ECOG) stage, treatment regimen, and number of cycles. As efficacy endpoints, progression-free survival (PFS) and overall survival (OS) were used. Analysis was performed using the Kaplan–Meier curve (SPSS Statistics v.24 program). Security was evaluated based on adverse effects (AEs), delays of therapy, reductions of doses, and suspensions associated with the treatment scheme.
Results Forty-one patients were included with median age 61.5 (47–79) years. There were 75.9% men and 24.1% women. ECOG stage was 0–1 in all cases. Twenty-eight patients received GemNab and thirteen FOLFIRINOX scheme. The median number of cycles was 4 (1–14) in GemNab group and 6 (1–18) in FOLFIRINOX population. Median PFS was 8 months (95% CI, 4 to 11) in GemNab group and 8 months (95% CI, 3 to 12) in FOLFIRINOX arm. Median OS was 7 months (95% CI, 2 to 11) in GemNab group and 8 months (95% CI, 3 to 12) in FOLFIRINOX population. The main AEs observed were asthenia (64.3%), neurotoxicity (25%) and diarrhoea (25%) for GemNab. This combination drug presented delays and reductions of doses in 60.7%, respectively, including suspensions due to AEs in 17.9%. Neurotoxicity (38.5%), diarrhoea (30.8%) and neutropenia (23.1%) were the AEs frequently reported in patients with the FOLFIRINOX scheme. Regarding tolerance of FOLFIRINOX, 84.6% delayed the cycle, 61.5% reduced the doses and 38.5% had treatment suspended.
Conclusion and relevance In our metastatic PC population, GemNab and FOLFIRINOX showed similar effectiveness. With respect to safety profile, more than half of the patients presented delays of therapy and reductions of doses in both groups and more patients discontinued treatment with the FOLFIRINOX regimen due to AEs.
Conflict of interest No conflict of interest
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