Gemcitabine Plus Nab-paclitaxel Versus FOLFIRINOX for Unresected Pancreatic Cancer: Comparative Effectiveness and Evaluation of Tumor Growth in Veterans

Overview

Journal Semin Oncol

Specialty Oncology

Date 2021 Mar 14

PMID 33714591

Citations 3

Authors

Keith Sigel

Mengxi Zhou

Yeun-Hee Anna Park

Tinaye Mutetwa

Girish Nadkarni

Celine Yeh

Paz Polak

Carlie Sigel

Thierry Conroy

Beata Juzyna

Mark Ychou

Tito Fojo

Juan P Wisnivesky

Susan E Bates

Affiliations

Soon will be listed here.

Abstract

Purpose: Advanced, unresectable pancreatic cancer is often treated with either gemcitabine plus nab-paclitaxel (Gem/NabP) or FOLFIRINOX, although these regimens have never been compared in a head-to-head trial. In this study, we compared these two regimens using Veterans Administration (VA) data and evaluated the use of a novel tumor growth formula to predict outcomes.

Methods: We identified 670 Veterans from national VA data with unresected stage II-IV pancreatic adenocarcinoma diagnosed between 2003 and 2016 who were treated with either first-line Gem/NabP or FOLFIRINOX. We compared overall survival (OS) and adverse events by treatment using propensity scores (PS) to account for allocation bias. Using longitudinal CA19-9 biomarker information we then fit the data to a novel tumor growth equation, comparing growth with OS.

Results: We found no difference in PS-adjusted (hazard ratio [HR] 1.00; 95% confidence interval [95% CI] 0.84-1.20) or PS-matched (HR: 0.93; 95% CI: 0.76-1.13) OS between the two treatment groups. Tumor growth analysis revealed similar growth parameter values for Gem/NabP and FOLFIRINOX (P = .074 for difference).

Conclusions: Gem/NabP appeared noninferior to FOLFIRINOX for survival outcomes for advanced pancreatic adenocarcinoma based on national VA data. Biomarker-based growth equations may be useful for monitoring treatment response and predicting prognosis for pancreatic cancer.

Citing Articles

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Folfirinox vs. Gemcitabine + Nab-Paclitaxel as the First-Line Treatment for Pancreatic Cancer: A Systematic Review and Meta-Analysis.

Merza N, Farooqui S, Dar S, Varughese T, Awan R, Qureshi L World J Oncol. 2023; 14(5):325-339.

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Tumor Growth Rate Informs Treatment Efficacy in Metastatic Pancreatic Adenocarcinoma: Application of a Growth and Regression Model to Pivotal Trial and Real-World Data.

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Stubbe B, Henriksen S, Madsen P, Larsen A, Krarup H, Pedersen I Cancers (Basel). 2021; 13(22).

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