Is FOLFOX+nab-paclitaxel a good alternative to FOLFIRINOX for pancreatic cancer?

It appears that adjuvant FOLFOX+nab-paclitaxel (FOLFOX-A) is useful as a multi-agent treatment regimen, indicating its potential as an alternative to FOLFIRINOX, a combination of cancer drugs including folinic acid, fluorouracil, irinotecan, and oxaliplatin, in patients with resected pancreatic ductal adenocarcinoma, suggests a recent study.

“Multiple clinical trials have established a role for adjuvant chemotherapy for patients with pancreatic ductal adenocarcinoma,” the authors said.

“Adjuvant FOLFIRINOX increases survival as compared with gemcitabine but with increased toxicity. FOLFOX-A was developed by the Brown University Oncology Research Group as an alternative to FOLFIRINOX,” they added.

This phase II trial examined the feasibility and toxicity of adjuvant FOLFOX-A in patients who had completed resection for pancreatic ductal adenocarcinoma. Those experiencing grade 2 neuropathy received a 20-percent reduction of oxaliplatin. Disease-free and overall survival were also analysed.

Twenty-five patients were recruited following surgical resection between June 2014 and October 2018. The median number of cycles completed was 9.5, while the median disease-free and overall survival were 19.7 months (95 percent confidence interval [CI], 10.3 to not reached) and 53.5 percent (95 percent CI, 24.2 to not reached), respectively.

The most frequent treatment-related grade ≥3 adverse event was fatigue (58 percent), followed by nausea (13 percent) and neutropaenia (26 percent). Grade 3 neuropathy developed in one patient (4 percent) and grade 2 neuropathy in 14 (58 percent). Only two patients (8 percent) experienced grade 3 diarrhoea.