Efficacy And Safety Of Gemcitabine-based And Modified FOLFIRINOX Chemotherapy For Advanced Pancreatic Cancer:A Clinical Comparison Study

Pancreatic cancer was the fourth leading cause of cancer-related death,with a 5-year survival rate of only 6%.More than 80% of patients are classified as having an unresectable stage at the time of diagnosis,as most patients are asymptomatic.Systemic chemotherapy is frequently used to treat this population,including Gemcitabine,S-1,Gemcitabine plus S-1/nab-paclitaxel/erlotinib,FOLFIRINOX.Gemcitabine plus erlotinib have generally shown little improvement of survival benefit compared with gemcitabine monotherapy,with low cost-effectiveness.No great progress has been made in the field of pancreatic cancer targeted therapy or immunotherapy,systemic chemotherapy still the major treatment.FOLFIRINOX regimen has been demonstrated could develop the survival benefit of MPC patients.Meanwhile,the oncologists always choose modified FOLFIRINOX in clinical practice for the relatively high incidence of grade 3/4 adverse events(AEs).Objective: To compare the efficacy and safety of modified FOLFIRINOX regimen(m FOLFIRINOX)versus gemcitabine-based as first-line chemotherapy for advanced pancreatic cancer.Methods: Retrospectively collected data of advanced pancreatic cancer patients in the department of medical oncology,Hangzhou First People’s Hospital,Hangzhou cancer hospital.Between January 2014 and December 2017,thirty-seven patients received gemcitabine-based chemotherapy which including gemcitabine alone(G),gemcitabine plus S-1(GS)or gemcitabine plus nab-paclitaxel as first-line chemotherapy(Arm A).Thirty-three patients were treated with m FOLFIRINOX(Arm B).The primary outcome was overall survival(OS),progression-free survival(PFS).The secondary outcomes were objective response rate(ORR)and grade 3/4 adverse events(AEs).Results: The median OS in two groups were 8.3 versus 13.5 months,P < 0.05.The PFS were 4.3 versus 6.1 months,P < 0.05.The ORR were 16.2% versus 36.4%,P﹥0.05.The most frequent grade 3/4 AEs in Arm A were neutropenia(16.2%),febrile neutropenia(10.8%),thrombocytopenia,allergic reaction and diarrhea(8.1%).In Arm B,neutropenia(12.1%),neuropathy and diarrhea(9.1%)were most frequent observed AEs.Conclusion: Modified FOLFIRINOX regimen has a significantly improved efficacy with similar tolerance in advanced pancreatic cancer,compared with gemcitabine-based chemotherapy.