Comparative effectiveness and resource utilization of nab-paclitaxel plus gemcitabine vs FOLFIRINOX or gemcitabine for the first-line treatment of metastatic pancreatic adenocarcinoma in a US community setting.
Comparative effectiveness and resource utilization of nab-paclitaxel plus gemcitabine vs FOLFIRINOX or gemcitabine for the first-line treatment of metastatic pancreatic adenocarcinoma in a US community setting.
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DOI：
10.2147/cmar.s126073
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发表时间：
2017
影响因子：
3.3
通讯作者：
Faria C
中科院分区：
文献类型：
--
作者：
Braiteh F;Patel MB;Parisi M;Ni Q;Park S;Faria C
尽管nab-紫杉醇联合吉西他滨和FOLFIRINOX与吉西他滨单药治疗转移性胰腺癌（mPC）相比具有临床相关、统计学显著的生存获益，但对其真实世界有效性知之甚少。我们使用具有全国代表性的电子病历数据库分析了mPC患者，以解决这一未满足的需求。这项对Navigating Cancer数据库的回顾性分析比较了接受一线nab-紫杉醇联合吉西他滨、FOLFIRINOX或吉西他滨治疗mPC的患者的结局。有效性，安全性和支持性护理的使用进行了检查。nab-紫杉醇加吉西他滨是统计学比较的参考。除年龄外，基线特征相似（年龄最大的患者在吉西他滨队列中，其次是nab-紫杉醇+吉西他滨，然后是FOLFIRINOX）。接受nab-紫杉醇加吉西他滨的患者（n=122）显示出相似的治疗中止时间（TTD;中位数，3.4 vs 3.8个月; P=0.947）和数据库持久性（DP;中位数，8.6 vs 8.6个月; P=0.534）vs FOLFIRINOX（n=80）;然而，TTD白蛋白结合型紫杉醇+吉西他滨组与吉西他滨组（n=46）相比，DP（中位数，3.4 vs 2.2个月; P<0.001）和DP（中位数，8.6 vs 5.3个月; P=0.030）显著更长。FOLFIRINOX或吉西他滨组的任何级别不良事件均多于nab-紫杉醇+吉西他滨组（分别为95%或89% vs 84%）。该真实世界分析证实了III期MPACT试验结果，并证明nab-紫杉醇联合吉西他滨治疗mPC的有效性与FOLFIRINOX相似，但耐受性更高，尽管FOLFIRINOX队列中的患者更年轻。这些结果支持白蛋白结合型紫杉醇加吉西他滨作为mPC患者的适当一线治疗选择。
Despite a clinically relevant, statistically significant survival benefit with nab-paclitaxel plus gemcitabine and FOLFIRINOX vs single-agent gemcitabine for metastatic pancreatic cancer (mPC), little is known regarding their real-world effectiveness. We analyzed patients with mPC using a nationally representative electronic medical records database to address this unmet need. This retrospective analysis of the Navigating Cancer database compared outcomes among patients who received first-line nab-paclitaxel plus gemcitabine, FOLFIRINOX, or gemcitabine for mPC. Effectiveness, safety, and supportive care use were examined. nab-Paclitaxel plus gemcitabine was the reference for statistical comparisons. Baseline characteristics were similar except age (oldest patients were in the gemcitabine cohort followed by nab-paclitaxel plus gemcitabine, then FOLFIRINOX). Patients receiving nab-paclitaxel plus gemcitabine (n=122) demonstrated similar time to treatment discontinuation (TTD; median, 3.4 vs 3.8 months; P=0.947) and database persistence (DP; median, 8.6 vs 8.6 months; P=0.534) vs FOLFIRINOX (n=80); however, TTD (median, 3.4 vs 2.2 months; P<0.001) and DP (median, 8.6 vs 5.3 months; P=0.030) were significantly longer with nab-paclitaxel plus gemcitabine vs gemcitabine (n=46). There were more any-grade adverse events with FOLFIRINOX or gemcitabine vs nab-paclitaxel plus gemcitabine (95% or 89% vs 84%, respectively). This real-world analysis confirms the phase III MPACT trial findings and demonstrates that nab-paclitaxel plus gemcitabine has effectiveness similar to that of FOLFIRINOX but greater tolerability for treating mPC despite younger patients being in the FOLFIRINOX cohort. These findings support nab-paclitaxel plus gemcitabine as an appropriate first-line treatment option for patients with mPC.