FOLFOX vs FOLFIRI as Second-line of Therapy After Progression to Gemcitabine/Nab-paclitaxel in Patients with Metastatic Pancreatic Cancer

Martina Catalano; Raffaele Conca; Roberto Petrioli; Monica Ramello; Giandomenico Roviello

doi:10.2147/CMAR.S267393

FOLFOX vs FOLFIRI as Second-line of Therapy After Progression to Gemcitabine/Nab-paclitaxel in Patients with Metastatic Pancreatic Cancer

Cancer Manag Res. 2020 Oct 19:12:10271-10278. doi: 10.2147/CMAR.S267393. eCollection 2020.

Authors

Martina Catalano¹, Raffaele Conca², Roberto Petrioli³, Monica Ramello⁴, Giandomenico Roviello⁵

Affiliations

¹ School of Human Health Sciences, University of Florence, Florence 50134, Italy.
² Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero, Vulture (PZ) 85028, Italy.
³ Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Siena 53100, Italy.
⁴ Oncology Unit, Department of Medical, Surgical, & Health Sciences, University of Trieste, Trieste, Italy.
⁵ Department of Health Sciences, University of Florence, Florence 50139, Italy.

Abstract

Background: Several progresses have been achieved for first-line chemotherapy in metastatic pancreatic ductal adenocarcinoma (PDAC) with Gem-NabP and FOLFIRINOX extensively used as standard first line regimens. However, the best second-line chemotherapy choice after progression is still not completely defined. The aim of this study is to compare effectiveness and safety of two possible second-line therapeutic options, FOLFOX and FOLFIRI, after progression to Gem-NabP.

Methods: From January 2015 to December 2018, patients with metastatic PDAC, progressed to the first-line treatment with Gem-NabP, and treated with a fluoropyrimidine-based second-line chemotherapy were considered eligible for our retrospective analysis. Overall survival (OS) and progression free survival (PFS) were set as primary endpoints whereas, disease control rate (DCR) and the rate and severity of treatment-related AEs were secondary endpoints.

Results: Overall, 31 patients were treated with Gem-NabP in first-line regimen, 11 received second-line with FOLFOX and 20 with FOLFIRI after progression. Baseline demographic and clinic features were similar in the two groups excluding median age of 55.5 years (range: 50-73) and 68 years (range: 59-72) in FOLFIRI and FOLFOX groups, respectively (p=0.002). Median PFS was three months (95%CI: 3-4), with no significative difference between the two groups. Median OS was eight months (95%CI: 5-10) and was significantly higher in the FOLFIRI group compared with the FOLFOX group, nine months (95%CI: 7-17) vs five months (95%CI: 2-10; p<0.01). The most commonly reported adverse events were grade 1 or 2 with anemia most frequent in the FOLFOX group (36.4% vs 10.0%) and diarrhea in the FOLFIRI group (40.0% vs 9.1%). Grade 3-4 adverse events as neutropenia, diarrhea and nausea/vomiting, occurred in 10 patients (32.2%) without differences between the two groups.

Conclusion: Our results seem to support the use of fluoropyrimidine-based second-line therapy for patients with metastatic pancreatic cancer, confirming the effectiveness and safety, to a greater extent with FOLFIRI regimen, after progression to the Gem-NabP.

Keywords: irinotecan; oxaliplatin; pancreatic cancer; second line.

Grants and funding

There is no funding to report.