- 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.
- 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.
- 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.
- 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.
- Post hoc analyses.