Ahn Daniel H, Krishna Kavya, Blazer Marlo, Reardon Joshua, Wei Lai, Wu Christina, Ciombor Kristen K, Noonan Anne M, Mikhail Sameh, Bekaii-Saab Tanios
Department of Internal Medicine, Division of Hematology/Medical Oncology, Mayo Clinic, Phoenix, AZ, USA.
Department of Medical Oncology, Ohio State University Wexner Medical Center, Richard Solove Research Institute and James Cancer Hospital, Columbus, OH, USA.
Ther Adv Med Oncol. 2017 Feb;9(2):75-82. doi: 10.1177/1758834016676011. Epub 2016 Nov 2.
Treatment with nab-paclitaxel with gemcitabine demonstrates a survival advantage when compared with single-agent gemcitabine. However, the combination is associated with significant toxicities, leading to a high rate of drug discontinuation. We implemented a modified regimen of gemcitabine and nab-paclitaxel (mGNabP) in an attempt to minimize toxicities while maintaining efficacy.
A total of 79 evaluable patients with metastatic pancreatic adenocarcinoma (mPC) treated with a modified regimen of gemcitabine (1000 mg/m) and nab-paclitaxel (125 mg/m) on days 1, 15 of every 28-day cycle were identified from our prospective database. A total of 57 patients received this regimen as first-line treatment and were evaluated for toxicities, progression-free survival (PFS), and overall survival (OS). Overall, 22 patients with advanced or metastatic PC treated with the modified regimen outside the first-line setting were only evaluated for toxicities.
The median OS and PFS were 10 months [95% confidence interval (CI) 5.9-13 months] and 5.4 months (95% CI 4.1-7.4 months) for patients that received the modified regimen as first-line therapy. Neurotoxicity occurred in 27% with only 1.6% of patients experiencing grade ⩾3 toxicity. The incidence of grade ⩾3 neutropenia was 19%, resulting in growth factor support in 12% of patients. This rate was similar in patients who received the modified regimen for first-line treatment of mPC the overall group.
A modified regimen of biweekly nab-paclitaxel with gemcitabine is associated with a lower cost, acceptable toxicity profile and appears to be relatively effective in pancreatic cancer. Prospective randomized studies confirming its potential benefits compared with standard weekly mGNabP are warranted.
与单药吉西他滨相比，纳米白蛋白结合型紫杉醇联合吉西他滨治疗显示出生存优势。然而，该联合方案具有显著毒性，导致药物停用率较高。我们实施了一种吉西他滨与纳米白蛋白结合型紫杉醇的改良方案（mGNabP），试图在保持疗效的同时将毒性降至最低。
从我们的前瞻性数据库中识别出79例可评估的转移性胰腺腺癌（mPC）患者，他们接受了每28天周期第1天和第15天的吉西他滨（1000mg/m²）与纳米白蛋白结合型紫杉醇（125mg/m²）改良方案治疗。共有57例患者接受该方案作为一线治疗，并对毒性、无进展生存期（PFS）和总生存期（OS）进行评估。总体而言，22例在一线治疗之外接受改良方案治疗的晚期或转移性PC患者仅评估了毒性。
接受改良方案作为一线治疗的患者，中位OS和PFS分别为10个月[95%置信区间（CI）5.9 - 13个月]和5.4个月（95%CI 4.1 - 7.4个月）。神经毒性发生率为27%，仅1.6%的患者出现≥3级毒性。≥3级中性粒细胞减少症的发生率为19%，12%的患者需要生长因子支持。在接受改良方案作为mPC一线治疗的患者中这一比例与总体组相似。
每两周一次的纳米白蛋白结合型紫杉醇与吉西他滨改良方案成本较低，毒性可接受，在胰腺癌中似乎相对有效。有必要进行前瞻性随机研究以证实其与标准每周mGNabP相比的潜在益处。
