nab-Paclitaxel Plus Gemcitabine Versus Gemcitabine in Patients with Metastatic Pancreatic Adenocarcinoma: Canadian Subgroup Analysis of the Phase 3 MPACT Trial

Mustapha Tehfe, Scot Dowden, Hagen Kennecke, Robert El-Maraghi, Bernard Lesperance, Felix Couture, Richard Letourneau, Helen Liu, Alfredo Romano, Mustapha Tehfe, Scot Dowden, Hagen Kennecke, Robert El-Maraghi, Bernard Lesperance, Felix Couture, Richard Letourneau, Helen Liu, Alfredo Romano

Abstract

Introduction: The phase III MPACT trial in patients with metastatic pancreatic cancer (MPC) demonstrated superior efficacy of nab-paclitaxel (nab-P) plus gemcitabine (Gem) compared with Gem monotherapy, including the primary endpoint of overall survival (OS; median 8.7 vs. 6.6 months; hazard ratio [HR] 0.72; P < 0.001). A significant treatment difference favoring nab-P + Gem over Gem was observed for OS in patients treated in North America. The majority of patients were from the US (88%) with only 12% from Canada. Healthcare systems and treatment patterns are different between the 2 countries, and there is limited published information on outcomes of Canadian patients treated with first-line nab-P + Gem. This analysis evaluated efficacy and safety outcomes in Canadian patients in the MPACT trial.

Methods: Treatment-naive patients with MPC (N = 861) received either nab-P 125 mg/m(2) + Gem 1000 mg/m(2) on days 1, 8, and 15 every 4 weeks or Gem 1000 mg/m(2) weekly for the first 7 of 8 weeks (cycle 1) and then on days 1, 8, and 15 every 4 weeks (cycle ≥2).

Results: The MPACT trial enrolled 63 patients in Canada. Baseline characteristics were well balanced and comparable with those of the intent-to-treat population. Both OS (median 11.9 vs. 7.1 months; HR 0.76; P = 0.373) and progression-free survival (median 7.2 vs. 5.2 months; HR 0.65; P = 0.224) were numerically longer and overall response rate (27% vs. 17%; P = 0.312) was numerically higher with nab-P + Gem vs. Gem. The most common grade ≥3 adverse events with nab-P + Gem vs. Gem were neutropenia (22% vs. 10%), fatigue (34% vs. 33%), and neuropathy (25% vs. 0%).

Conclusion: This subanalysis confirmed that nab-P + Gem is an efficacious treatment option and has a manageable safety profile in patients with MPC treated in Canada.

Trial registration: ClinicalTrials.gov identifier, NCT00844649.

Funding: Celgene Corporation, Summit, NJ, USA.

Keywords: Canada; Gemcitabine; MPACT; Metastatic pancreatic cancer; Oncology; Subgroup analysis; nab-Paclitaxel.

Figures

Fig. 1
Fig. 1
Overall survival in Canadian patients. Kaplan–Meier curve of overall survival for patients in Canada treated with either nab-paclitaxel + gemcitabine or gemcitabine alone. P value was generated from a log-rank test. CI confidence interval, Gem gemcitabine, HR hazard ratio, nab-Pnab-paclitaxel

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