NEJM EvidenceNab-Paclitaxel plus Gemcitabine and FOLFOX in Metastatic Pancreatic Cancer

Enhanced Outcomes with Nab-Paclitaxel Plus Gemcitabine and FOLFOX in Metastatic Pancreatic Cancer

The recent phase II trial has critically evaluated the effectiveness and safety of sequential nab-paclitaxel plus gemcitabine followed by modified FOLFOX-6 (nab-P/Gem-mFOLFOX) in comparison with the standard treatment of nab-paclitaxel plus gemcitabine (nab-P/Gem) for patients with untreated metastatic pancreatic ductal adenocarcinoma (mPDAC). This study presents a significant advancement in the quest for optimizing first-line treatment strategies for mPDAC, shedding light on both the potential benefits and increased toxicity associated with the sequential treatment regimen.

Study Design:

• Participants: 157 patients with untreated metastatic pancreatic ductal adenocarcinoma (mPDAC) were randomized in a 1:1 ratio.
• Treatment Groups: Patients received either nab-P/Gem on days 1, 8, and 15 followed by mFOLFOX on day 29 of a 6-week cycle (experimental group), or nab-P/Gem on days 1, 8, and 15 of a 4-week cycle (control group).
• Primary Endpoint: The 12-month overall survival rate.

Key Findings:

• 12-Month Survival Rate: 55.3% in the nab-P/Gem-mFOLFOX group vs. 35.4% in the nab-P/Gem group (P=0.02).
• 24-Month Survival Rate: 22.4% with nab-P/Gem-mFOLFOX vs. 7.6% with control treatment.
• Median Overall Survival: 13.2 months for nab-P/Gem-mFOLFOX vs. 9.7 months for nab-P/Gem.
• Toxicity: Higher incidence of grade 3 or higher neutropenia and thrombocytopenia, and two treatment-related deaths in the nab-P/Gem-mFOLFOX group.

HCN Medical Memo
The phase II trial demonstrates that sequential nab-P/Gem-mFOLFOX treatment significantly improves survival in metastatic pancreatic cancer patients, offering a promising avenue for enhancing standard care despite an increase in treatment-related toxicity.

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