Optimizing Chemotherapy Choice in the Treatment of Advanced Pancreatic Cancer—It Is Complicated
Menée au Canada à partir de données portant sur 5 465 patients atteints d'un cancer du pancréas de stade avancé traité entre 2008 et 2018, cette étude de cohorte rétrospective compare l'efficacité, du point de vue de la survie globale, de deux stratégies de chimiothérapie de première ligne, l'une de type GEMNAB (gemcitabine et nab-paclitaxel) et l'autre de type FOLFIRINOX (fluorouracile, leucovorine, irinotécan et oxaliplatine)
Pancreatic ductal adenocarcinoma (PDAC) is a highly fatal cancer and is expected to become the second most common cause of cancer-related death in the US by 2040.1 Most patients present with advanced disease at the time of diagnosis with systemic chemotherapy as their primary treatment option. In 2011, fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX) was compared with what was considered the standard of care, gemcitabine, in a phase 3 trial involving 342 patients with untreated metastatic pancreatic cancer.2 The combination regimen showed an improvement in median overall survival from 6.8 to 11.1 months (hazard ration [HR] 0.57; 95% CI 0.45-0.73; P < .001). Two years later, Von Hoff and colleagues published the results of the randomized phase 3 trial comparing gemcitabine-nab-paclitaxel (GEMNAB) with gemcitabine in patients with metastatic pancreatic cancer.3 The addition of nab-paclitaxel to gemcitabine improved median overall survival from 6.7 to 8.5 months (HR 0.72; 95% CI 0.62-0.83; P < .001). The demographics included in each study were very different, and to date, there are no large clinical trials comparing FOLFIRINOX directly to GEMNAB with both regimens recommended as first-line treatment for advanced pancreatic cancer.
JAMA Network Open , commentaire en libre accès, 2020