Williet Nicolas, Saint Angélique, Pointet Anne-Laure, Tougeron David, Pernot Simon, Pozet Astrid, Bechade Dominique, Trouilloud Isabelle, Lourenco Nelson, Hautefeuille Vincent, Locher Christophe, Desrame Jérome, Artru Pascal, Thirot Bidault Anne, Le Roy Bertrand, Pezet Denis, Phelip Jean-Marc, Taieb Julien
Hepatogastroenterology Department, University Hospital of Saint-Etienne, Avenue Albert Raimond, Saint-Etienne 42270, France.
Department of Medical Oncology, Antoine Lacassagne Center, Nice, France.
Therap Adv Gastroenterol. 2019 Sep 25;12:1756284819878660. doi: 10.1177/1756284819878660. eCollection 2019.
Folfirinox (FFX) and gemcitabine/nab-paclitaxel (GN) are both standard first-line treatments in patients with metastatic pancreatic cancer (mPC). However, data comparing these two chemotherapeutic regimens and their sequential use remain scarce.
Data from two independent cohorts enrolling patients treated with FFX ( = 107) or GN ( = 109) were retrospectively pooled. Primary endpoint was overall survival (OS). Progression-free survival (PFS) was the secondary endpoint. A propensity score based on age, gender, performance status (PS), and presence of liver metastases was used to make groups comparable.
In the whole study population, OS was significantly higher in FFX (14 months; 95% CI: 10-21) than in GN groups (9 months; 95% CI: 8-12) before ( = 0.008) and after ( = 0.021) adjusting for age, number of metastatic sites, liver metastases, peritoneal carcinomatosis and CA19.9 level at baseline. PFS tends to be higher in FFX (6 months) than GN groups (5 months; = 0.053). After matching ( = 49/group), patients were comparable for all baseline characteristics including PS. In the matched population, there was a trend toward greater OS in patients treated with FFX (HR = 0.67; = 0.097). However, survival in each group was not solely a result of the first-line regimen. The proportion of patients who were fit for GN after FFX failure (FFX-GN sequence) was higher (46.9%) than the reverse sequence (20.4%; = 0.01), which suggests a higher feasibility for the FFX-GN sequence. Corresponding median OS were 19 months 9.5 months, respectively ( = 0.094).
This study shows greater OS with FFX than with GN in patients with mPC. GN after FFX failure appears more feasible than the reverse sequence.
氟尿嘧啶/亚叶酸钙/伊立替康/奥沙利铂（FFX）和吉西他滨/纳米白蛋白结合型紫杉醇（GN）都是转移性胰腺癌（mPC）患者的标准一线治疗方案。然而，比较这两种化疗方案及其序贯使用的数据仍然很少。
回顾性汇总了两个独立队列中接受FFX（n = 107）或GN（n = 109）治疗患者的数据。主要终点是总生存期（OS）。无进展生存期（PFS）是次要终点。使用基于年龄、性别、体能状态（PS）和肝转移情况的倾向评分使各分组具有可比性。
在整个研究人群中，在调整年龄、转移部位数量、肝转移、腹膜种植转移和基线CA19.9水平之前（P = 0.008）和之后（P = 0.021），FFX组的OS（14个月；95% CI：10 - 21）显著高于GN组（9个月；95% CI：8 - 12）。FFX组的PFS（6个月）倾向于高于GN组（5个月；P = 0.053）。匹配后（每组n = 49），患者在包括PS在内的所有基线特征方面具有可比性。在匹配人群中，接受FFX治疗的患者有OS更长的趋势（HR = 0.67；P = 0.097）。然而，每组的生存期并非仅由一线治疗方案决定。FFX治疗失败后适合接受GN治疗（FFX - GN序贯）的患者比例（46.9%）高于相反序贯（20.4%；P = 0.01），这表明FFX - GN序贯具有更高的可行性。相应的中位OS分别为19个月和9.5个月（P = 0.094）。
本研究表明，mPC患者中FFX组的OS长于GN组。FFX治疗失败后使用GN似乎比相反序贯更可行。
