Muranaka Tetsuhito, Kuwatani Masaki, Komatsu Yoshito, Sawada Kentaro, Nakatsumi Hiroshi, Kawamoto Yasuyuki, Yuki Satoshi, Kubota Yoshimasa, Kubo Kimitoshi, Kawahata Shuhei, Kawakubo Kazumichi, Kawakami Hiroshi, Sakamoto Naoya
Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Kita-14-Jyou Nishi-5-Choume, Kita-ku, Sapporo, Hokkaido, Japan.
Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Kita-14-Jyou Nishi-5-Choume, Kita-ku, Sapporo, Hokkaido, Japan.
J Gastrointest Oncol. 2017 Jun;8(3):566-571. doi: 10.21037/jgo.2017.02.02.
Irinotecan, oxaliplatin and leucovorin-modulated fluorouracil (FOLFIRINOX) and the combination regimen of gemcitabine and nanoparticle albumin-bound paclitaxel (GnP) (nab-PTX) improve the prognosis of patients with metastatic pancreatic cancer. However, no study has compared the efficacy of the two regimens. We compared retrospectively the efficacy and safety of the two regimens in patients with unresectable pancreatic cancer.
Thirty-eight patients with unresectable locally advanced or metastatic pancreatic cancer received FOLFIRINOX or GnP as first-line chemotherapy between December 2013 and September 2015. In the FOLFIRINOX group, patients received 85 mg/m oxaliplatin followed by 180 mg/m irinotecan and 200 mg/m L-leucovorin, and by 400 mg/m fluorouracil as a bolus and 2,400 mg/m fluorouracil as a 46-h continuous infusion every 14 days. In the GnP group, patients received 125 mg/m nab-PTX followed by 1 g/m, and gemcitabine on days 1, 8 and 15, repeated every 28 days.
Response rate was 6.3% in the FOLFIRINOX group and 40.9% in the GnP group (P=0.025). Median progression-free survival (PFS) was 3.7 months [95% confidence interval (CI), 3.0-4.5] in the FOLFIRINOX group and 6.5 months (95% CI, 6.2-6.9 months) in the GnP group (P=0.031). Drug toxicity in the GnP group was less than in the FOLFIRINOX group.
Efficacy and safety of GnP compare favorably to those of FOLFIRINOX in patients with pancreatic cancer. Additional prospective trials are warranted.
伊立替康、奥沙利铂和亚叶酸钙调节的氟尿嘧啶（FOLFIRINOX）以及吉西他滨与纳米白蛋白结合型紫杉醇（GnP）（白蛋白结合型紫杉醇）的联合方案可改善转移性胰腺癌患者的预后。然而，尚无研究比较这两种方案的疗效。我们回顾性比较了这两种方案在不可切除胰腺癌患者中的疗效和安全性。
2013年12月至2015年9月期间，38例不可切除的局部晚期或转移性胰腺癌患者接受FOLFIRINOX或GnP作为一线化疗。在FOLFIRINOX组中，患者接受85mg/m²奥沙利铂，随后是180mg/m²伊立替康和200mg/m²左亚叶酸钙，以及400mg/m²氟尿嘧啶推注和2400mg/m²氟尿嘧啶持续输注46小时，每14天一次。在GnP组中，患者接受125mg/m²白蛋白结合型紫杉醇，随后是1g/m²吉西他滨，于第1、8和15天给药，每28天重复一次。
FOLFIRINOX组的缓解率为6.3%，GnP组为40.9%（P=0.025）。FOLFIRINOX组的中位无进展生存期（PFS）为3.7个月[95%置信区间（CI），3.0-4.5]，GnP组为6.5个月（95%CI，6.2-6.9个月）（P=0.031）。GnP组的药物毒性低于FOLFIRINOX组。
在胰腺癌患者中，GnP的疗效和安全性优于FOLFIRINOX。有必要进行更多的前瞻性试验。
