Nab-paclitaxel plus gemcitabine for metastatic pancreatic adenocarcinoma after Folfirinox failure: an AGEO prospective multicentre cohort

Alix Portal, Simon Pernot, David Tougeron, Claire Arbaud, Anne Thirot Bidault, Christelle de la Fouchardière, Pascal Hammel, Thierry Lecomte, Johann Dréanic, Romain Coriat, Jean-Baptiste Bachet, Olivier Dubreuil, Lysiane Marthey, Laetitia Dahan, Belinda Tchoundjeu, Christophe Locher, Céline Lepère, Franck Bonnetain, Julien Taieb, Alix Portal, Simon Pernot, David Tougeron, Claire Arbaud, Anne Thirot Bidault, Christelle de la Fouchardière, Pascal Hammel, Thierry Lecomte, Johann Dréanic, Romain Coriat, Jean-Baptiste Bachet, Olivier Dubreuil, Lysiane Marthey, Laetitia Dahan, Belinda Tchoundjeu, Christophe Locher, Céline Lepère, Franck Bonnetain, Julien Taieb

Abstract

Background: There is currently no standard second-line treatment for metastatic pancreatic adenocarcinoma (MPA), and progression-free survival is consistently <4 months in this setting. The aim of this study was to evaluate the efficacy and tolerability of Nab-paclitaxel plus gemcitabine (A+G) after Folfirinox failure in MPA.

Methods: From February 2013 to July 2014, all consecutive patients treated with A+G for histologically proven MPA after Folfirinox failure were prospectively enrolled in 12 French centres. A+G was delivered as described in the MPACT trial, until disease progression, patient refusal or unacceptable toxicity.

Results: Fifty-seven patients were treated with Nab-paclitaxel plus gemcitabine, for a median of 4 cycles (range 1-12). The disease control rate was 58%, with a 17.5% objective response rate. Median overall survival (OS) was 8.8 months (95% CI: 6.2-9.7) and median progression-free survival was 5.1 months (95% CI: 3.2-6.2). Since the start of first-line chemotherapy, median OS was 18 months (95% CI: 16-21). No toxic deaths occurred. Grade 3-4 toxicities were reported in 40% of patients, consisting of neutropenia (12.5%), neurotoxicity (12.5%), asthenia (9%) and thrombocytopenia (6.5%).

Conclusions: A+G seems to be effective, with a manageable toxicity profile, after Folfirinox failure in patients with MPA.

Figures

Figure 1
Figure 1
OS and PFS.
Figure 2
Figure 2
OS and PFS since the beginning of first-line chemotherapy. OS1+2: Overall survival since the beginning of first-line chemotherapy. PFS1+2: Progression-free survival since the beginning of first-line chemotherapy.

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