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Comparative Study
. 2020 Jan;9(1):160-169.
doi: 10.1002/cam4.2705. Epub 2019 Nov 13.

Real-world outcomes of FOLFIRINOX vs gemcitabine and nab-paclitaxel in advanced pancreatic cancer: A population-based propensity score-weighted analysis

Kelvin K W Chan  1   2   3 , Helen Guo  1 , Sierra Cheng  2 , Jaclyn M Beca  3   4 , Ruby Redmond-Misner  4 , Wanrudee Isaranuwatchai  3   4 , Lucy Qiao  1 , Craig Earle  2   5 , Scott R Berry  2 , James J Biagi  6 , Stephen Welch  7 , Brandon M Meyers  8 , Nicole Mittmann  1 , Natalie Coburn  2 , Jessica Arias  1 , Deborah Schwartz  1 , Wei F Dai  1 , Scott Gavura  1 , Robin McLeod  1 , Erin D Kennedy  1   9
Affiliations
Comparative Study

Real-world outcomes of FOLFIRINOX vs gemcitabine and nab-paclitaxel in advanced pancreatic cancer: A population-based propensity score-weighted analysis

Kelvin K W Chan et al. Cancer Med. 2020 Jan.

Abstract

Background: In Ontario, FOLFIRINOX (FFX) and gemcitabine + nab-paclitaxel (GnP) have been publicly funded for first-line unresectable locally advanced pancreatic cancer (uLAPC) or metastatic pancreatic cancer (mPC) since April 2015. We examined the real-world effectiveness and safety of FFX vs GnP for advanced pancreatic cancer, and in uLAPC and mPC.

Methods: Patients receiving first-line FFX or GnP from April 2015 to March 2017 were identified in the New Drug Funding Program database. Baseline characteristics and outcomes were obtained through the Ontario Cancer Registry and other population-based databases. Overall survival (OS) was assessed using Kaplan-Meier and weighted Cox proportional hazard models, weighted by the inverse propensity score adjusting for baseline characteristics. Weighted odds ratio (OR) for hospitalization and emergency department visits (EDV) were estimated from weighted logistic regression models.

Results: For 1130 patients (632 FFX, 498 GnP), crude median OS was 9.6 and 6.1 months for FFX and GnP, respectively. Weighted OS was improved for FFX vs GnP (HR = 0.77, 0.70-0.85). Less frequent EDV and hospitalization were observed in FFX (EDV: 67.8%; Hospitalization: 49.2%) than GnP (EDV: 77.7%; Hospitalization: 59.3%). More frequent febrile neutropenia-related hospitalization was observed in FFX (5.8%) than GnP (3.3%). Risk of EDV and hospitalization were significantly lower for FFX vs GnP (EDV: OR = 0.68, P = .0001; Hospitalization: OR = 0.76, P = .002), whereas the risk of febrile neutropenia-related hospitalization was significantly higher (OR = 2.12, P = .001). Outcomes for uLAPC and mPC were similar.

Conclusion: In the real world, FFX had longer OS, less frequent all-cause EDV and all-cause hospitalization, but more febrile neutropenia-related hospitalization compared to GnP.

Keywords: FOLFIRINOX; gemcitabine; outcomes; pancreatic cancer; real-world evidence.

PubMed Disclaimer

Conflict of interest statement

Brandon Meyers: Speakers bureau—Celgene.

Figures

Figure 1
Figure 1
Overall survival for patients with (A) advanced pancreatic cancer, (B) metastatic pancreatic cancer (mPC), and (C) unresectable locally advanced pancreatic cancer (uLAPC). FFX, FOLFIRINOX; GnP, gemcitabine + nab‐paclitaxel
Figure 2
Figure 2
Forest plot of hazard ratios of overall mortality for FFX vs GnP in each sub‐group from weighted Cox proportional hazard model. ECOG PS, Eastern Co‐operative Oncology Group performance status; FFX, FOLFIRINOX; GnP, gemcitabine + nab‐paclitaxel
See this image and copyright information in PMC

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