Three fluoropyrimidine-based regimens in routine clinical practice after nab-paclitaxel plus gemcitabine for metastatic pancreatic cancer: An AGEO multicenter study - 20/06/20
, David Tougeron b, Simon Pernot a, Astrid Pozet c, Dominique Béchade d, Isabelle Trouilloud e, Nelson Lourenco f, Vincent Hautefeuille g, Christophe Locher h, Nicolas Williet i, Jérôme Desrame j, Pascal Artru j, Emilie Soularue k, Bertrand Le Roy l, Julien Taieb aBienvenue sur EM-consulte, la référence des professionnels de santé.
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Summary |
Background |
A combination of nab-paclitaxel plus gemcitabine (N+G) has recently become a standard first-line treatment in patients with metastatic pancreatic adenocarcinoma (MPA), but there are currently no published data concerning second-line treatment after N+G. The aim of this study was to evaluate the survival outcomes and tolerability of three usual fluoropyrimidine-based regimens FOLFOX, FOLFIRI and FOLFIRINOX after N+G failure in MPA patients.
Methods |
Patients receiving N+G as first-line regimen were prospectively identified in 11 French centers between January 2014 and January 2017. After disease progression or unacceptable toxicity, patients eligible for second-line therapy were enrolled in the study. The primary endpoint was overall survival following the second-line regimen. Secondary endpoints were objective response, progression-free survival and safety.
Results |
Out of 137 patients treated with N+G as first-line regimen, 61 (44.5%) received second-line chemotherapy, including FOLFOX (39.4%), FOLFIRI (34.4%) or FOLFIRINOX (26.2%). Baseline characteristics were not different between the 3 groups. In particular, median age was 71.7 years, sex ratio was 1/1, and performance status (PS) was 0 in 11.5% of case. Main grade 3 toxicities were neutropenia (4.9%) and nausea (3.3%), without major differences between the groups. No toxic death was observed. Median second-line progression-free survival (PFS) and overall survival (OS) were 2.95 (95% CI: 2.3–5.4) and 5.97 months (95% CI: 4.0–8.0), respectively, with no difference between the 3 groups. Median OS from the start of first-line chemotherapy was 12.7 months (10.4–15.1) and was significantly better in patients receiving FOLFIRI after N+G failure, 18.4 months (95% CI: 11.7-24.1, P<0.05), as compared with FOLFOX or FOLFIRINOX (10.4 and 12.3 months, respectively).
Conclusion |
This study suggests that second-line fluoropyrimidine-based regimens after N+G failure are feasible, have a manageable toxicity profile in selected patients with MPA, and are associated with promising clinical outcomes, in particular when combined with irinotecan. Randomized phase 3 trials are needed to confirm this trend.
Le texte complet de cet article est disponible en PDF.Keywords : Metastatic pancreatic cancer, Nab-paclitaxel plus gemcitabine, Second-line chemotherapy, FOLFIRINOX, FOLFIRI, FOLFOX
Plan
Vol 44 - N° 3
P. 295-301 - juin 2020 Retour au numéro
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