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