Pancreatic cancer: how to choose between first-line regimens

  • Shi S & al.
  • Semin Oncol
  • 27 Dec 2018

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • In pancreatic cancer, performance status and baseline carbohydrate antigen 19-9 (CA19-9) levels may help dictate the choice between FOLFIRINOX (oxaliplatin, irinotecan, fluorouracil, and leucovorin) and NG (nab-paclitaxel and gemcitabine).

Why this matters

  • Results could help guide treatment selection.

Study design

  • Analysis of institutional data (n=69) and 2 phase 3 clinical trials.
  • Funding: National Science Foundation for Distinguished Young Scholars of China; Shanghai Sailing Program.

Key results

  • At the researchers' center, more patients receiving NG than FOLFIRINOX experienced a ≥20% reduction in CA19-9 (74.5% vs 45.5%; P=.029).
  • In 2 phase 3 trials, FOLFIRINOX was linked to lower mortality in patients with normal CA19-9 levels vs abnormal levels (HR, 0.42 vs 0.58).
  • NG vs gemcitabine alone (CA19-9):
    • Elevated ≥59 × upper limit of normal (ULN): HR, 0.61.
    • Elevated
    • Normal: HR, 1.07.
  • Recommendations for palliative therapy: advanced pancreatic cancer:
    • Performance status (PS) 2: NG.
    • PS 0-1:
      • Normal CA19-9: FOLFIRINOX.
      • Elevated CA19-9 (
      • Elevated CA19-9 (≥59 × ULN): NG.
  • Recommendations for resected pancreatic cancer:
    • R0 resection margin: adjuvant therapy with 5-FU/oral prodrugs of FU over gemcitabine.
    • R1 resection margin: gemcitabine or gemcitabine-based regimens.

Limitations

  • Post hoc analyses.

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