Analysis points to FOLFIRINOX chemotherapy benefits for metastatic pancreatic cancer
By Lynda Williams, medwireNews Reporter
FOLFIRINOX (folinic acid, fluorouracil, irinotecan hydrochloride and oxaliplatin) chemotherapy may offer better survival than gemcitabine plus nab-paclitaxel for patients with metastatic pancreatic ductal adenocarcinoma, suggests a comparative effectiveness study published in JAMA Network Open.
Dvir Aran (Technion-Israel Institute of Technology, Haifa, Israel) and fellow investigators used clinical data from the AIM Specialty Health-Anthem Cancer Care Quality Program and health insurance claims to compare overall survival (OS) for the two pancreatic cancer regimens.
“[O]ur data set includes a wide set of features that should be considered to match baseline differences across patients receiving different treatment regimens” and “represents a highly diverse population” of 1102 individuals attending 388 clinics for stage IV disease in the USA between 2016 and 2019, they write.
The researchers found that patients treated with FOLFIRINOX were younger than those given gemcitabine plus nab-paclitaxel (median 59.1 vs 61.2 years), had a better ECOG performance status score (PS; 39.3 vs 32.8% with PS=0), and lower median values for both the Charlson Comorbidity Index (0.0 vs 1.0) and the social deprivation index (36.0 vs 42.0).
When an age- and propensity score-matched cohort of 456 patients for each treatment was assessed, median OS was significantly longer with FOLFIRINOX than gemcitabine plus nab-paclitaxel (9.27 vs 7.10 months) and a similar pattern was found after inverse probability of treatment weighting (IPTW) adjustment for confounding factors (9.27 vs 6.87 months).
And intention-to-treat IPTW analysis further increased the significant difference in median OS between the FOLFIRINOX and gemcitabine plus nab-paclitaxel groups (9.20 vs 6.08 months), therefore “rejecting the hypothesis that early mortality or worse prognosis may explain the superiority of FOLFIRINOX”, say Aran et al.
Improved OS with a hazard ratio of 1.30 with FOLFIRINOX was also found in multivariate analysis adjusting for factors including PS, age, social deprivation index and metastases, Aran et al report.
Finally, FOLFORINOX was estimated to result in a significant 17.3% fewer hospital stays in the 2 weeks after treatment than gemcitabine plus nab-paclitaxel, increasing to 28.0% among those with a poor PS, as well as a significant 20.0% reduction in post-treatment costs.
The researchers admit that the study design has limitations, including lack of data on clinical decision-making and absence of information on other clinically relevant outcomes, such as progression-free survival, quality of life and toxicity.
Nevertheless, they conclude that their findings “support the need for a randomized clinical trial comparing these regimens.”
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JAMA Netw Open 2022; 5: e2216199