Real World First-Line Treatments and Outcomes of Nab-Paclitaxel Plus Gemcitabine, mFOLFIRINOX and GEMOX in Unresectable Pancreatic Cancer from a Chinese Single Institution

• Main Authors: Qi Quan, Yixing Wang, Fenghua Wang, Dongsheng Zhang, Xiuxing Chen, Wenzhuo He, Bei Zhang, Guifang Guo
• Format: Article
• Language: English
• Published: MDPI AG 2021-12-01
• Series: Current Oncology
• Subjects: pancreatic cancer; chemotherapy; nab-paclitaxel plus gemcitabine; mFOLFIRINOX; GEMOX
• Online Access: https://www.mdpi.com/1718-7729/28/1/23
• ISSN: 1198-0052; 1718-7729

Background: There have not been any head-to-head prospective studies to compare the effects of different chemotherapy regimens as first-line treatments for unresectable pancreatic cancer (UPC). We aimed to compare the effectiveness of nab-paclitaxel plus gemcitabine, mFOLFIRINOX and gemcitabine plus oxaliplatin (GEMOX) as first-line treatments by using real-world data from Chinese patients. Methods: We retrospectively included patients with UPC treated with nab-paclitaxel plus gemcitabine, mFOLFIRINOX or GEMOX as a first-line treatment at Sun Yat-sen University Cancer Center. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR) were assessed. Results: A total of 117 patients were administered nab-paclitaxel plus gemcitabine (<i>n</i> = 62), mFOLFIRINOX (<i>n</i> = 30) or GEMOX (<i>n</i> = 25) as first-line chemotherapy. The median OS was 11.1, 10.1 and 10.2 months (<i>p</i> = 0.75) in the nab-paclitaxel plus gemcitabine, mFOLFIRINOX and GEMOX, respectively. The ORR was similar among the three groups (24%, 23% and 32%, <i>p</i> = 0.76) and the DCR was higher in the nab-paclitaxel-gemcitabine group (82%) than the other two groups (60% and 64%, <i>p</i> = 0.04). The most common adverse events of grade 3 or 4 were neutropenia (32%, 28% and 5%), peripheral neuropathy (13%, 16% and 0) and fatigue (9%, 16% and 5%). Febrile neutropenia occurred in 2%, 4% and 5% of the patients in the three groups. Conclusion: In the first line treatment of UPC, our results suggest that nab-paclitaxel plus gemcitabine was associated with a higher DCR than mFOLFIRINOX or GEMOX, while all groups demonstrated similar OS, PFS and ORR.