Publication: Prognostic factors for survival with nab-paclitaxel plus gemcitabine in metastatic pancreatic cancer in real-life practice: the ANICE-PaC study.
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Identifiers
Date
2018-11-29
Authors
Fernández, Ana
Salgado, Mercedes
García, Adelaida
Buxò, Elvira
Vera, Ruth
Adeva, Jorge
Jiménez-Fonseca, Paula
Quintero, Guillermo
Llorca, Cristina
Cañabate, Mamen
Advisors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
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. 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. 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). 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.
Description
MeSH Terms
Adult
Aged
Albumins
Antineoplastic Combined Chemotherapy Protocols
Comorbidity
Deoxycytidine
Female
Humans
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Staging
Paclitaxel
Pancreatic Neoplasms
Prognosis
Retrospective Studies
Survival Analysis
Treatment Outcome
Gemcitabine
Aged
Albumins
Antineoplastic Combined Chemotherapy Protocols
Comorbidity
Deoxycytidine
Female
Humans
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Staging
Paclitaxel
Pancreatic Neoplasms
Prognosis
Retrospective Studies
Survival Analysis
Treatment Outcome
Gemcitabine
DeCS Terms
CIE Terms
Keywords
First-line chemotherapy, Gemcitabine, Metastatic pancreatic adenocarcinoma, Nab-paclitaxel, Real-life, Survival