Efficacy and safety of nab-paclitaxel in combination with gemcitabine for metastatic pancreatic cancer

Abstract

Background: Metastatic pancreatic cancer (MPC) is one of the most fatal malignancies with extremely high mortality. Nab-paclitaxel plus gemcitabine have been commonly used in patients with MPC on the basis of positive results from recent randomized controlled trial. The purpose of this study was to evaluate efficacy and safety of this combination chemotherapy in real clinical practice. Methods: Patients diagnosed with MPC based on pathologic findings and treated with nab-paclitaxel plus gemcitabine between June 2015 and July 2017 were included. Medical records about patient demographics, laboratory and image findings, and cycles and doses of chemotherapy were retrospectively reviewed in total of 101 patients. Overall survival (OS) and progression free survival (PFS) were estimated by Kaplan-Meier method and Cox proportional hazard regression linear model was applied to assess the prognostic factors. Results: Median age was 62.1±9.5, and 64 patients (63.4%) were male. Metastasis was identified most commonly in liver followed by peritoneum and lung

61 patients (60.4%), 30 patients (29.7%) and 19 patients (18.8%), respectively. Patients received total cycles of 6.2±3.6 during 5.7±3.7 months. Median OS and PFS were 14.7 and 7.3 months, respectively. Tumor control was achieved in 73 patients (72.3%)

overall partial response in 27 patients (26.7%) and stable disease in 46 patients (45.5%). Multivariable Cox analysis showed poor survival in patients with liver metastasis (HR = 2.15, 95% CI 1.07 – 4.31

p= 0.027). Several adverse events over grade 3 were observed as follows

neutropenia in 41 patients (40.6%), anemia in 23 patients (22.8%) and peripheral neuropathy in 15 patients (14.9%). Febrile neutropenia occurred in 6 patients (5.9%) during follow-up. Conclusions: Combination chemotherapy of gemcitabine and nab-paclitaxel for patients with MPC showed significant survival advantage and is a reasonable choice in palliative setting. However, careful attention for development of hematologic adverse events and severe peripheral neuropathy is required.