RT Journal Article
T1 From First Line to Sequential Treatment in the Management of Metastatic Pancreatic Cancer.
A1 Martín, Andrés Muñoz
A1 Hidalgo, Manuel
A1 Alvarez, Rafael
A1 Arrazubi, Virginia
A1 Martínez-Galán, Joaquina
A1 Salgado, Mercedes
A1 Macarulla, Teresa
A1 Carrato, Alfredo
K1 FOLFIRINOX
K1 chemotherapy
K1 metastatic disease
K1 nab-paclitaxel + gemcitabine
K1 pancreatic cancer
K1 sequential treatment
AB The current management of patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) is based on systemic chemotherapy. The results of the MPACT and PRODIGE clinical trials have demonstrated that the combination of nab-paclitaxel and gemcitabine (GEM) as well as FOLFIRINOX regimen result in improvement in overall survival when compared to GEM alone. Treatment guidelines now recommend either one of these two regimens as first line treatment for fit patients with mPDAC. Because no head-to-head comparison between the two regimens exists, the selection of one versus the other is based on clinical criteria. The design and eligibility criteria of these two clinical trials are dissimilar, making the results of the MPACT trial more applicable to the general population of patients with mPDAC. In addition, the combination of nab-paclitaxel and GEM is better tolerated and easier to administer in clinical practice than FOLFIRINOX. Furthermore, when the regimens are studied in comparable patient populations the efficacy results are very similar. Nanoliposomal irinotecan plus 5FU has recently demonstrated a significant increase in efficacy rates after a GEM-based treatment. Importantly, treatment of mPDAC should now be considered as a continuum care for patients who are fit, with second and even third line treatments. Different sequential treatment algorithms are proposed based on available data. In retrospective studies, patients who were managed with GEM-based regimens followed by fluoropyrimidine-based regimens appear to have the most favorable outcome.
SN 1837-9664
YR 2018
FD 2018-04-30
LK https://hdl.handle.net/10668/26128
UL https://hdl.handle.net/10668/26128
LA en
DS RISalud
RD Apr 5, 2025