Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam.
Center for Liver Cancer.
Am J Clin Oncol. 2020 Sep;43(9):654-659. doi: 10.1097/COC.0000000000000730.
By using the Korean Pancreatic Cancer (K-PaC) registry, we compared the clinical outcomes of FOLFIRINOX (FFX) and gemcitabine plus nab-paclitaxel (GNP) in patients with metastatic pancreatic cancer (MPC).
We constructed a web-based database of 3748 anonymized patients diagnosed with pancreatic ductal adenocarcinoma. MPC patients who received first-line FFX or GNP were enrolled. Overall survival (OS), progression-free survival, grade III to IV toxicity, and cross-over treatment were analyzed.
A total of 413 patients (232 vs. 181, FFX vs. GNP; all data are presented in this sequence) were eligible. Median age was 63 years (60 vs. 69 y) with 43% (39% vs. 47%) comprising female individuals. The major metastatic sites were the liver (64%), peritoneum (25%), and distant lymph nodes (18%). The median OS was 11.5 versus 12.7 months (hazard ratio [HR]=0.87, 95% confidence interval [CI]: 0.68-1.12, P=0.286), and median progression-free survival was 7.5 versus 8.1 months (HR=0.92, 95% CI: 0.70-1.20, P=0.517), respectively. The frequency of grade III to IV febrile neutropenia was higher in the FFX group (18% vs. 11%, P=0.040), and that of peripheral neuropathy was higher in the GNP group (8% vs. 14%, P=0.046). The chance to receive second-line chemotherapy was higher in the GNP group (45% vs. 56%, P=0.036). In the cross-over treatment, the median OS of the FFX-GNP group (n=43) and the GNP-FFX group (n=47) was 16.8 versus 17.7 months (HR=0.79, 95% CI: 0.44-1.41, P=0.425).
FFX and GNP showed similar efficacy and comparable toxicity in MPC patients. Although the GNP group had a higher chance to receive second-line chemotherapy, they did not have improved overall survival.
通过使用韩国胰腺癌（K-PaC）登记处，我们比较了转移性胰腺癌（MPC）患者中 FOLFIRINOX（FFX）和吉西他滨加 nab-紫杉醇（GNP）的临床结局。
我们构建了一个基于网络的 3748 名匿名诊断为胰腺导管腺癌患者的数据库。招募接受一线 FFX 或 GNP 治疗的 MPC 患者。分析总生存期（OS）、无进展生存期、III 至 IV 级毒性和交叉治疗。
共有 413 名患者（232 名 vs. 181 名，FFX 组 vs. GNP 组；所有数据均按此顺序呈现）符合条件。中位年龄为 63 岁（60 岁 vs. 69 岁），43%（39% vs. 47%）为女性。主要转移部位为肝脏（64%）、腹膜（25%）和远处淋巴结（18%）。中位 OS 为 11.5 个月与 12.7 个月（风险比[HR]=0.87，95%置信区间[CI]：0.68-1.12，P=0.286），中位无进展生存期为 7.5 个月与 8.1 个月（HR=0.92，95% CI：0.70-1.20，P=0.517）。FFX 组 III 至 IV 级发热性中性粒细胞减少症的发生率较高（18% vs. 11%，P=0.040），GNP 组周围神经病变的发生率较高（8% vs. 14%，P=0.046）。GNP 组接受二线化疗的机会较高（45% vs. 56%，P=0.036）。在交叉治疗中，FFX-GNP 组（n=43）和 GNP-FFX 组（n=47）的中位 OS 分别为 16.8 个月与 17.7 个月（HR=0.79，95% CI：0.44-1.41，P=0.425）。
FFX 和 GNP 在 MPC 患者中显示出相似的疗效和相当的毒性。尽管 GNP 组接受二线化疗的机会较高，但他们的总生存期并未得到改善。
