Ghosn Marwan, Ibrahim Tony, Assi Tarek, El Rassy Elie, Kourie Hampig Raphael, Kattan Joseph
Marwan Ghosn, Tony Ibrahim, Tarek Assi, Elie El Rassy, Hampig Raphael Kourie, Joseph Kattan, Department of Oncology, Faculty of Medicine, Saint Joseph University, Beirut 166830, Lebanon.
World J Gastroenterol. 2016 Dec 14;22(46):10124-10130. doi: 10.3748/wjg.v22.i46.10124.
Pancreatic cancer is one of the deadliest cancers, ranking fourth among cancer-related deaths. Despite all the major molecular advances and treatment breakthroughs, mainly targeted therapies, the cornerstone treatment of metastatic pancreatic cancer (mPC) remains cytotoxic chemotherapy. In 2016, more than 40 years after the introduction of gemcitabine in the management of mPC, the best choice for first-line treatment has not yet been fully elucidated. Two main strategies have been adopted to enhance treatment efficacy. The first strategy is based on combining non-cross resistant drugs, while the second option includes the development of newer generations of chemotherapy. More recently, two new regimens, FOLFIRINOX and gemcitabine/nab-paclitaxel (GNP), have both been shown to improve overall survival in comparison with gemcitabine alone, at the cost of increased toxicity. Therefore, the best choice for first line therapy is a matter of debate. For some authors, FOLFIRINOX should be the first choice in patients with an Eastern Cooperative Oncology Group score (0-1) given its lower hazard ratio. However, others do not share this opinion. In this paper, we review the main comparison points between FOLFIRINOX and GNP. We analyze the two pivotal trials to determine the similarities and differences in study design. In addition, we compare the toxicity profile of the two regimens as well as the impact on quality of life. Finally, we present studies revealing real life experiences and review the advantages and disadvantages of possible second-line therapies including their cost effectiveness.
胰腺癌是最致命的癌症之一，在癌症相关死亡中排名第四。尽管在主要分子研究方面取得了所有重大进展以及治疗方面取得了突破，主要是靶向治疗，但转移性胰腺癌（mPC）的基石治疗仍然是细胞毒性化疗。2016年，在吉西他滨用于mPC治疗引入40多年后，一线治疗的最佳选择仍未完全阐明。为提高治疗效果采取了两种主要策略。第一种策略是基于联合使用非交叉耐药药物，而第二种选择包括开发新一代化疗药物。最近，两种新方案，即FOLFIRINOX和吉西他滨/纳米白蛋白结合型紫杉醇（GNP），与单独使用吉西他滨相比，均已显示可提高总生存期，但代价是毒性增加。因此，一线治疗的最佳选择存在争议。对于一些作者来说，鉴于其较低的风险比，FOLFIRINOX应该是东部肿瘤协作组评分为（0 - 1）的患者的首选。然而，其他人并不认同这一观点。在本文中，我们回顾了FOLFIRINOX和GNP之间的主要比较要点。我们分析了两项关键试验，以确定研究设计中的异同。此外，我们比较了两种方案的毒性特征以及对生活质量的影响。最后，我们展示了揭示实际临床经验的研究，并回顾了包括成本效益在内的可能二线治疗的优缺点。
