Document Type : Original Article(s)

Authors

Department of Internal Medicine, Hematology/Oncology Division, American University of Beirut Medical Center, Beirut, Lebanon

Abstract

Background: Pancreatic cancer is characterized by its generally poor prognosis and ranks seventh worldwide in cancer-related mortality. We previously conducted a prospective study on the use of modified GTX regimen (a combination of gemcitabine, docetaxel, and capecitabine), which has appreciable activity and is well-tolerated, in this setting. We compared the efficacy of GTX regimen versus Gemcitabine-nabpaclitaxel (GmAb) as second-line chemotherapy in advanced pancreatic cancer patients receiving first-line therapy with FOLFIRINOX.
Method: This retrospective chart review aimed to collect and record data corresponding to patients diagnosed with advanced pancreatic cancer at the American University of Beirut Medical Center who received FOLFIRINOX as first-line chemotherapy and who then had GTX or GmAb as second-line treatment between 2013 and 2019. We measured the progression-free survival, overall survival, and toxicity of GTX versus GmAb as second-line treatment for pancreatic adenocarcinoma at AUBMC.
Results: The median overall survival for the GmAb group was around 52 months, which is greater than that of the GTX group, which was 25 months. 26.7% of patients who received GTX required dose reduction starting from cycle one, while only 3.1% of those who received GmAb required dose reduction from cycle one. 38.7% of patients who received GmAb did not have anemia throughout the course of treatment, while the majority of patients who received GTX, 93.3%, had grade I anemia.
Conclusion: Our data show that GmAb is a possibly better second-line treatment option than GTX with better tolerance to the dose, less anemia, and a better survival profile. More studies are needed with a larger sample size and a prospective design to prove such a possible difference between the two regimens.

Highlights

Sally Temraz (Google Scholar)

Ali Shamseddine (Google Scholar)

Keywords

How to cite this article:

Temraz S, Kreidieh F, Nassar F, Mezher M, Mukherji D, Shamseddine A. Second-line modified GTX versus Gemcitabine-Nab-Paclitaxel (GmAb) following first-line FOLFIRINOX in advanced pancreatic cancer: a retrospective analysis at the American University of Beirut Medical Center (AUBMC). Middle East J Cancer. 2023;14(4):550-8. doi: 10.30476/mejc.2023.95050.1770.

  1. Lekka K, Tzitzi E, Giakoustidis A, Papadopoulos V, Giakoustidis D. Contemporary management of borderline resectable pancreatic ductal adenocarcinoma. Ann Hepatobiliary Pancreat Surg. 2019;23(2):97-108. doi: 10.14701/ahbps.2019.23.2.97.
  2. Ruarus A, Vroomen L, Puijk R, Scheffer H, Meijerink M. Locally advanced pancreatic cancer: a review of local ablative therapies. Cancers (Basel). 2018;10(1):16. doi: 10.3390/cancers10010016.
  3. Yıldırım S, Erdoğan AP, Karateke M, Yılmaz C, Özveren A, Bulut G, et al. Metastatic pancreatic cancer second-line treatment options: is the difference only in cost? J Gastrointest Cancer. 2022;53(1):41-4. doi: 10.1007/s12029-020-00573-y.
  4. National Comprehensive Cancer Network (NCCN). Pancreatic Adenocarcinoma (Version 1.2021). Available at: https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf
  5. Ajouz H, Mukherji D, Haydar A, Yakan AS, Saleh A, Elias E, et al. Modified GTX as second-line therapy for advanced pancreatic adenocarcinoma. J Gastrointest Cancer. 2014;45(1):109-12. doi: 10.1007/s12029-013-9571-x.
  6. Mostafa ME, Erbarut-Seven I, Pehlivanoglu B, Adsay V. Pathologic classification of "pancreatic cancers": current concepts and challenges. Chin Clin Oncol. 2017;6(6):59. doi: 10.21037/cco.2017.12.01.
  7. Paluri RK, Kasi A, Young C, Posey JA. Second-line treatment for metastatic pancreatic cancer. Clin Adv Hematol Oncol. 2020;18:106-15.
  8. Pelzer U, Schwaner I, Stieler J, Adler M, Seraphin J, Dörken B, et al. Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: a phase III-study from the German CONKO-study group. Eur J Cancer. 2011;47(11):1676-81. doi: 10.1016/j.ejca.2011.04.011.
  9. Wang-Gillam A, Li CP, Bodoky G, Dean A, Shan YS, Jameson G, et al. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. 2016;387(10018):545-57. doi: 10.1016/S0140-6736(15)00986-1.
  10. Dakik HK, Moskovic DJ, Carlson PJ, Tamm EP, Qiao W, Wolff RA, et al. The use of GTX as second-line and later chemotherapy for metastatic pancreatic cancer: a retrospective analysis. Cancer Chemother Pharmacol. 2012;69(2):425-30. doi: 10.1007/s00280-011-1705-x.
  11. Catalano M, Conca R, Petrioli R, Ramello M, Roviello G. FOLFOX vs FOLFIRI as second-line of therapy after progression to gemcitabine/nab-paclitaxel in patients with metastatic pancreatic cancer. Cancer Manag Res. 2020;12:10271-8. doi: 10.2147/CMAR.S267393.
  12. Foschini F, Napolitano F, Servetto A, Marciano R, Mozzillo E, Carratù AC, et al. FOLFIRINOX after first-line gemcitabine-based chemotherapy in advanced pancreatic cancer: a retrospective comparison with FOLFOX and FOLFIRI schedules. Ther Adv Med Oncol. 2020;12:1758835920947970. doi: 10.1177/1758835920947970.