BMC Cancer (Nov 2018)

Prognostic factors for survival with nab-paclitaxel plus gemcitabine in metastatic pancreatic cancer in real-life practice: the ANICE-PaC study

  • Ana Fernández,
  • Mercedes Salgado,
  • Adelaida García,
  • Elvira Buxò,
  • Ruth Vera,
  • Jorge Adeva,
  • Paula Jiménez-Fonseca,
  • Guillermo Quintero,
  • Cristina Llorca,
  • Mamen Cañabate,
  • Luis Jesús López,
  • Andrés Muñoz,
  • Patricia Ramírez,
  • Paula González,
  • Carlos López,
  • Margarita Reboredo,
  • Elena Gallardo,
  • Manuel Sanchez-Cánovas,
  • Javier Gallego,
  • Carmen Guillén,
  • Nuria Ruiz-Miravet,
  • Víctor Navarro-Pérez,
  • Juan De la Cámara,
  • Inmaculada Alés-Díaz,
  • Roberto Antonio Pazo-Cid,
  • Alberto Carmona-Bayonas

DOI
https://doi.org/10.1186/s12885-018-5101-3
Journal volume & issue
Vol. 18, no. 1
pp. 1 – 11

Abstract

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Abstract Background Treatment with nab-paclitaxel plus gemcitabine increases survival in patients with metastatic pancreatic cancer. However, the assessment of treatment efficacy and safety in non-selected patients in a real-life setting may provide useful information to support decision-making processes in routine practice. Methods Retrospective, multicenter study including patients with metastatic pancreatic cancer, who started first-line treatment with nab-paclitaxel plus gemcitabine between December 2013 and June 2015 according to routine clinical practice. In addition to describing the treatment pattern, overall survival (OS) and progression-free survival (PFS) were assessed for the total sample and the exploratory subgroups based on the treatment and patients’ clinical characteristics. Results All 210 eligible patients had a median age of 65.0 years (range 37–81). Metastatic pancreatic adenocarcinoma was recurrent in 46 (21.9%) patients and de novo in 164 (78.1%); 38 (18%) patients had a biliary stent. At baseline, 33 (18.1%) patients had an ECOG performance status ≥2. Patients received a median of four cycles of treatment (range 1–21), with a median duration of 3.5 months; 137 (65.2%) patients had a dose reduction of nab-paclitaxel and/or gemcitabine during treatment, and 33 (17.2%) discontinued treatment due to toxicity. Relative dose intensity (RDI) for nab-paclitaxel, gemcitabine, and the combined treatment was 66.7%. Median OS was 7.2 months (95% CI 6.0–8.5), and median PFS was 5.0 months (95% CI 4.3–5.9); 50 patients achieved either a partial or complete response (ORR 24.6%). OS was influenced by baseline ECOG PS, NLR and CA 19.9, but not by age ≥ 70 years and/or the presence of hepatobiliary stent or RDI 3 vs. ≤ 3 (p = 0.043), and baseline CA 19.9 > 37 U/mL vs. ≤37 U/mL (p = 0.004). Conclusions Nab-Paclitaxel plus gemcitabine remain effective in a real-life setting, despite the high burden of dose reductions and poorer performance of these patients. A nomogram to predict survival using baseline ECOG performance status, NLR and CA 19.9 is proposed.

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