Comparison of efficacy and toxicity of FOLFIRINOX and gemcitabine with nab-paclitaxel in unresectable pancreatic cancer
Comparison of efficacy and toxicity of FOLFIRINOX and gemcitabine with nab-paclitaxel in unresectable pancreatic cancer
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DOI：
10.21037/jgo.2017.02.02
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发表时间：
2017-06-01
影响因子：
2.1
通讯作者：
Sakamoto, Naoya
中科院分区：
文献类型：
--
作者：
Muranaka, Tetsuhito;Kuwatani, Masaki;Sakamoto, Naoya
背景：伊立替康、奥沙利铂和亚叶酸钙调节的氟尿嘧啶(FOLFIRINOX)和吉西他滨联合纳米白蛋白结合紫杉醇(NAB-PTX)方案可改善转移性胰腺癌患者的预后。然而，还没有研究比较这两种方案的疗效。方法：从2013年12月至2015年9月，38例不能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。FOLFIRINOX组先用奥沙利铂85 mg/m2，后加伊立替康180 mg/m(2)、L-亚叶酸钙200 mg/m(2)，氟尿嘧啶400 mg/m(2)团注，2400 mg/m(2)氟尿嘧啶46h持续滴注，每14d一次。结果：GNP组有效率为6.3%，GNP组有效率为40.9%(P=0.025)。中位无进展生存期(PFS)：FOLFIRINOX组为3.7月[95%可信区间(CI)3.0~4.5月]，GNP组为6.5月(95%CI，6.2~6.9月)(P=0.031)。GNP组药物毒性低于FOLFIRINOX组。结论：GNP治疗胰腺癌的疗效和安全性优于FOLFIRINOX。有必要进行更多的前瞻性试验。
Background: 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.Methods: 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/m2 oxaliplatin followed by 180 mg/m(2) irinotecan and 200 mg/m(2) L-leucovorin, and by 400 mg/m(2) fluorouracil as a bolus and 2,400 mg/m(2) fluorouracil as a 46-h continuous infusion every 14 days. In the GnP group, patients received 125 mg/m(2) nab-PTX followed by 1g/m(2), and gemcitabine on days 1, 8 and 15, repeated every 28 days.Results: 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.Conclusions: Efficacy and safety of GnP compare favorably to those of FOLFIRINOX in patients with pancreatic cancer. Additional prospective trials are warranted.