Comparison between FOLFIRINOX and gemcitabine plus nab-paclitaxel including sequential treatment for metastatic pancreatic cancer: a propensity score matching approach
Jung Won Chun,
Sang Hyub Lee,
Joo Seong Kim,
Namyoung Park,
Gunn Huh,
In Rae Cho,
Woo Hyun Paik,
Ji Kon Ryu,
Yong-Tae Kim
Affiliations
Jung Won Chun
Center for Liver and Pancreatobiliary Cancer, Research Institute and Hospital, National Cancer Center
Sang Hyub Lee
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine
Joo Seong Kim
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine
Namyoung Park
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine
Gunn Huh
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine
In Rae Cho
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine
Woo Hyun Paik
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine
Ji Kon Ryu
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine
Yong-Tae Kim
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine
Abstract Background FOLFIRINOX (FFX) and Gemcitabine plus nab-paclitaxel (GnP) have been recommended as the first-line chemotherapy for metastatic pancreatic cancer (mPC). However, the evidence is lacking comparing not only two regimens, but also sequential treatment (FFX–GnP vs. GnP–FFX). Methods Data of 528 patients (FFX, n = 371; GnP, n = 157) with mPC were collected retrospectively. Propensity score matching was conducted to alleviate imbalance of the two groups. Overall survival (OS), progression free survival (PFS), and toxicity of patients were analyzed. Results In the whole population, OS (12.5 months vs. 10.3 months, P = 0.05) and PFS (7.1 months vs. 5.8 months, P = 0.02) were longer in the FFX group before matching and after matching (OS: 11.8 months vs. 10.3 months, P = 0.02; PFS: 7.2 months vs. 5.8 months, P < 0.01). For sequential treatment, OS and PFS showed no significant difference. Interruptions of chemotherapy due to toxicities were more frequent (6.8 vs. 29.3%, P < 0.001) in the GnP group, and cessation of chemotherapy showed a significant association with mortality (z = − 1.94, P = 0.03). Conclusions FFX achieved a longer overall survival than GnP in mPC, but not in the comparison for sequential treatment. More frequent adverse events followed by treatment interruptions during GnP might lead to a poor survival outcome. Therefore, FFX would be a better first-line treatment option than GnP for mPC.
