FOLFIRINOX shows survival advantage in frontline pancreatic cancer

  • Williet N & al.
  • Therap Adv Gastroenterol
  • 1 Jan 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A retrospective comparison suggests that FOLFIRINOX (fluoropyrimidine, oxaliplatin, and irinotecan) offers a survival advantage over gemcitabine/nab-paclitaxel (Gem/nab-paclitaxel) in frontline metastatic pancreatic ductal adenocarcinoma (mPDAC).
  • The effect appears driven by greater fitness for second-line Gem/nab-paclitaxel after FOLFIRINOX failure than for the reverse sequence.

Why this matters

  • This is the first propensity-matched analysis of patients treated with these standard frontline therapies.

Study design

  • Retrospective analysis of 2 cohorts (n=216).
  • Funding: None.

Key results

  • OS was higher in patients treated with FOLFIRINOX (median, 14.0 months vs 9.0 months; HR, 0.65; P=.008).
    • This advantage was maintained after adjusting for age, number of metastatic sites, liver metastases, peritoneal carcinomatosis, and baseline CA19.9 level (HR, 0.62; P=.021).

  • After propensity score matching (n=49/group):
    • PFS was similar between groups (HR, 0.77; P=.22).
    • OS trended higher in the FOLFIRINOX group (14.0 months vs 9.0 months; HR, 0.67; P=.097).
    • A greater proportion of patients underwent second-line therapy after FOLFIRINOX vs Gem/nab-paclitaxel failure (46.9% vs 20.4%; P=.009).
    • Median OS trended higher in 23 patients who received FOLFIRINOX first than in 10 receiving Gem/nab-paclitaxel first (19 months vs 9.5 months; HR, 0.46; P=.094).

Limitations

  • Retrospective analysis.