Use of nab-paclitaxel and gemcitabine in pancreatic cancer without granulocyte colony-stimulating factor: A multicenter real-world experience.

Abstract

INTRODUCTION:

The metastatic pancreatic adenocarcinoma clinical trial (MPACT) trial established gemcitabine (gem) and nab-paclitaxel (nab) as a standard treatment for pancreatic cancer utilizing granulocyte colony-stimulating factors to manage neutropenia. This was a challenge for jurisdictions that do not use granulocyte colony-stimulating factors in palliative settings. We developed dosage guidelines to dose modify gem and nab without granulocyte colony-stimulating factors. We undertook a retrospective review to determine the efficacy and safety of these dose adjustment guidelines in the real world.

METHODS:

A multi-centered, retrospective chart review was performed on pancreatic patients between December 1, 2014, and August 21, 2018. Provincial electronic medical health records were reviewed. Using Log-rank statistics we determined the patient's progression-free survival and overall survival.

RESULTS:

Of 248 patients, 209 met patient selection criteria. Patients were excluded if they were lost to follow-up, on gem alone prior to nab/gem combination therapy or did not receive nab or gem. Patients who received nab/gem as first-line therapy had a median progression-free survival of 6.3 months (95% CI, 5.1-7.4), and median overall survival of 11.1 months (95% CI, 9.5-12.8). Those who received gem/nab in the second line had a median progression-free survival of 4.6 months (95% CI, 2.8-6.5), and median overall survival of 19.3 months (95% CI, 12.6-26.0).

CONCLUSIONS:

The patient's progression-free survival and overall survival taking nab/gem using our dose modification algorithm were equivalent or superior to the MPACT trial's progression-free survival and overall survival. Gem/nab can be given by our dose modification scheme without granulocyte colony-stimulating factor.

• Authors: Angela Chen, Vincent H Ha, Sunita Ghosh, Carole R Chambers, Michael B Sawyer
• Journal: Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners (J Oncol Pharm Pract) Vol. 28 Issue 7 Pg. 1594-1602 (Oct 2022) ISSN: 1477-092X [Electronic] England
• PMID: 34612732 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• 130-nm albumin-bound paclitaxel
• Albumins
• Colony-Stimulating Factors
• Deoxycytidine
• Paclitaxel
• Gemcitabine

Topics

• Adenocarcinoma (drug therapy)
• Albumins (adverse effects)
• Antineoplastic Combined Chemotherapy Protocols
• Colony-Stimulating Factors (therapeutic use)
• Deoxycytidine (analogs & derivatives)
• Granulocytes (pathology)
• Humans
• Paclitaxel
• Pancreatic Neoplasms
• Retrospective Studies
• Treatment Outcome
• Gemcitabine
• Pancreatic Neoplasms