Gemcitabine plus nab‐paclitaxel versus FOLFIRINOX for unresected pancreatic cancer: Comparative effectiveness and evaluation of tumor growth in Veterans

Keith Sigel, Mengxi Zhou, Yeun Hee Anna Park, Tinaye Mutetwa, Girish Nadkarni, Celine Yeh, Paz Polak, Carlie Sigel, Thierry Conroy, Béata Juzyna, Mark Ychou, Tito Fojo, Juan P. Wisnivesky, Susan E. Bates

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Purpose: Advanced, unresectable pancreatic cancer is often treated with either gemcitabine plus nab-paclitaxel (Gem/NabP) or FOLFIRINOX, although these regimens have never been compared in a head-to-head trial. In this study, we compared these two regimens using Veterans Administration (VA) data and evaluated the use of a novel tumor growth formula to predict outcomes. Methods: We identified 670 Veterans from national VA data with unresected stage II-IV pancreatic adenocarcinoma diagnosed between 2003 and 2016 who were treated with either first-line Gem/NabP or FOLFIRINOX. We compared overall survival (OS) and adverse events by treatment using propensity scores (PS) to account for allocation bias. Using longitudinal CA19-9 biomarker information we then fit the data to a novel tumor growth equation, comparing growth with OS. Results: We found no difference in PS-adjusted (hazard ratio [HR] 1.00; 95% confidence interval [95% CI] 0.84–1.20) or PS-matched (HR: 0.93; 95% CI: 0.76–1.13) OS between the two treatment groups. Tumor growth analysis revealed similar growth parameter values for Gem/NabP and FOLFIRINOX (P = .074 for difference). Conclusions: Gem/NabP appeared noninferior to FOLFIRINOX for survival outcomes for advanced pancreatic adenocarcinoma based on national VA data. Biomarker-based growth equations may be useful for monitoring treatment response and predicting prognosis for pancreatic cancer.

Original languageEnglish
Pages (from-to)69-75
Number of pages7
JournalSeminars in Oncology
Volume48
Issue number1
DOIs
StatePublished - Feb 2021

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