Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 2Efficacy and toxicity of FOLFIRINOX versus gemcitabine/nab paclitaxel as first-line therapy for patients with mPAC
2:25 minutes.
TRANSCRIPTION:
DR LOVE: Tony, any comments? You put this slide together trying to indirectly compare the regimens. Maybe you can kind of walk us through it and what your thoughts are about it. DR BEKAII-SAAB: And I think that’s always a dangerous exercise, to try to compare 2 studies that are very different. This is really to emphasize the fact that they are very different. The FOLFIRINOX study was done only in mostly centers of excellence. And 1 country, in France, a smaller study, performance status was a little bit better selected. The “head” versus “non-head” was an issue, but you see the same with nab paclitaxel. I mean, the concern with hyper-biluribinemia and either a taxane or irinotecan. So that’s about similar. When you look at the overall survival and the progression-free survival, the PFS is close. The survival is historically better with FOLFIRINOX, which is one of the main drivers why folks have been more geared toward using this regimen in better-performance patients. But keep in mind that, if you look at the countries that were involved in both studies, it was, again, 1 country, France, with select centers. The gemcitabine/nab paclitaxel study was done in multiple parts of the world, including Eastern Europe, which essentially has very little access to salvage regimens. So these are patients who may not have had the access to a second-line regimen, which we know can affect survival. The toxicities, again, are different between the two — a little bit more with FOLFIRINOX. But as Margaret alluded to, giving weekly gemcitabine/nab paclitaxel is not really a trip in the park itself. You always have to drop one or the other. DR LOVE: So I’m just kind of curious. You’ve been talking back and forth about first-line therapy, Margaret, the issue of the mix of people who walk in the door. I’m sure probably there are a lot younger patients coming to see you. But globally, what fraction of your patients get FOLFIRINOX up front? What fraction get nab/gem? DR TEMPERO: If you talk about our off-study patients, which is kind of a small number, it’s probably half and half. And it really depends, as I said before, on kind of our own and our nurses’ assessment of what we think they will tolerate and their own preference about what they want to tolerate. If they don’t want to have alopecia, we know what we need to go to. |