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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2020; 12(2): 182-194
Published online Feb 15, 2020. doi: 10.4251/wjgo.v12.i2.182
FOLFIRINOX vs gemcitabine/nab-paclitaxel for treatment of metastatic pancreatic cancer: Single-center cohort study
In Rae Cho, Huapyong Kang, Jung Hyun Jo, Hee Seung Lee, Moon Jae Chung, Jeong Youp Park, Seung Woo Park, Si Young Song, Chansik An, Mi-Suk Park, Seungmin Bang
In Rae Cho, Department of Internal Medicine, International Saint Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon 22711, South Korea
In Rae Cho, Department of Medicine, Yonsei University Graduate School, 50-1 Yonsei-ro, Seoul 03722, South Korea
Huapyong Kang, Jung Hyun Jo, Hee Seung Lee, Moon Jae Chung, Jeong Youp Park, Seung Woo Park, Si Young Song, Seungmin Bang, Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul 03722, South Korea
Chansik An, Mi-Suk Park, Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul 03722, South Korea
Author contributions: Cho IR analyzed and interpreted data and wrote the paper; Kang H, Jo JH, Lee HS, Chung MJ performed the data analysis; Park JY interpreted data and performed statistical analysis; Park SW, Song SY interpreted data and supervised study; An C, Park MS analyzed and interpreted radiologic findings; Bang S interpreted data and designed and supervised study.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
STROBE statement: The authors have read the STROBE Statement–checklist of items, and the manuscript was prepared and revised according to the STROBE Statement–checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Seungmin Bang, MD, PhD, Professor, Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. bang7028@yuhs.ac
Received: October 11, 2019
Peer-review started: October 11, 2019
First decision: November 11, 2019
Revised: December 19, 2019
Accepted: December 30, 2019
Article in press: December 30, 2019
Published online: February 15, 2020
ARTICLE HIGHLIGHTS
Research background
FOLFIRINOX regimen and combination of gemcitabine and nab-paclitaxel (Gem + nabPTX) are recommended as the first-line therapy for metastatic pancreatic cancer. However, there is a lack of data regarding a direct comparison of the two regimens in efficacy and safety.
Research motivation
When treating metastatic pancreatic cancer patients, physicians would like to select appropriate chemotherapeutic regimens while avoiding and preventing unnecessary complications and economic burdens. By comparing the efficacy and safety of two regimens, this study can help physicians’ decision of treatment choice and sequence.
Research objectives
The purpose of this study is to compare the efficacy, safety, and economic aspects of FOLFIRINOX and Gem + nabPTX in the treatment of metastatic pancreatic cancer in Korean population.
Research methods
Patients with metastatic or recurrent pancreatic cancer treated with FOLFIRINOX (n = 86) or Gem + nabPTX (n = 81) as the first-line since January 2015 were identified using the Severance Hospital Pancreatic Cancer Cohort Registry. Treatment efficacy, treatment-related adverse events and economic aspects were compared.
Research results
The median overall survival (FOLFIRINOX 10.7 vs Gem + nabPTX 12.1 mo; P = 0.157), progression-free survival (FOLFIRINOX 8.0 vs Gem + nabPTX 8.4 mo; P = 0.134), and objective response rates (FOLFIRINOX 33.7% vs Gem + nabPTX 46.9%; P = 0.067) were not significantly different between two regimens. Neurologic adverse events were more common in the Gem + nabPTX group and Grade ≥ 3 neutropenia and gastrointestinal adverse events were more common in the FOLFIRINOX group. The drug costs of both regimens were similar.
Research conclusions
Treatment efficacy and economic burdens were comparable between the two regimens. But, the type and rates of the adverse events were somewhat different. Given the subgroup analysis of this study, Gem + nabPTX regimen might be considered preferentially in patients with specific baseline conditions.
Research perspectives
This study will help clinicians choose an appropriate chemotherapeutic regimen for metastatic pancreatic cancer. To confirm and validate the results of this study, a larger scale prospective study would be helpful.
