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Home All Specialties Chronic Disease

Nab-paclitaxel plus gemcitabine improves survival in metastatic pancreatic cancer

bys25qthea
October 30, 2013
in Chronic Disease, Endocrinology, Gastroenterology, Oncology
Reading Time: 3 mins read
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Image: PD 

1. Nab-paclitaxel plus gemcitabine improved overall survival, progression-free survival, and response rate compared to gemcitabine alone in advanced pancreatic cancer. 

2. Combination therapy was associated with higher rates of reversible myelosuppression and peripheral neuropathy. 

Evidence Rating Level: 1 (Excellent)       

Study Rundown: Despite recent progress, prognosis for metastatic pancreatic cancer remains poor. This phase 3 trial suggests that addition of nab-paclitaxel to standard gemcitabine therapy results in a clinically active regimen against pancreatic adenocarcinoma. The study authors cautioned that although the combined regimen had higher clinical activity, it was also associated with higher rates of adverse events, particularly neutropenia and peripheral neuropathy. As a result, not all patients may be eligible for this regimen, especially if the patient has underlying myelosuppression or neuropathy from other disease processes.

This large, multicentre trial included patients from North America, Europe and Australia. The combination regimen of nab-paclitaxel plus gemcitabine improved overall survival and response rates. Although combination therapy was associated with higher rates of adverse events, the rate of serious life-threatening events was not increased.

Click to read the study, published today in NEJM

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Relevant Reading: Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial

In-Depth [randomized, controlled trial]: This study analyzed the efficacy and safety of adding nab-paclitaxel (albumin-bound paclitaxel) to gemcitabine in treating metastatic pancreatic adenocarcinoma. The study randomly assigned 861 patients in a 1:1 ratio to receive nab-paclitaxel plus gemcitabine or gemcitabine alone. The primary endpoint was overall survival. Secondary endpoints included progression-free survival and overall response rate assessed by independent radiographic review.

The nab-paclitaxel-gemcitabine group had a median survival of 8.5 months (95% CI, 7.89 to 9.53) compared to 6.7 months (95% CI, 6.01 to 7.23; hazard ratio for death, 0.72) in the gemcitabine group. The combined regimen was associated with higher 1-year and 2-year survival rates. Nab-paclitaxel-gemcitabine was also superior to gemcitabine alone in progression-free survival, with a median of 5.5 months (95% CI, 4.5 to 5.9) versus 3.7 months (95% CI, 3.6 to 4.0; hazard ratio for progression or death, 0.69). The rate of progression-free survival at 1 year was 16% in the combined regimen group compared to 9% in the gemcitabine group. The response rate was higher in the nab-paclitaxel-gemcitabine group (23%; 95% CI: 19 to 27) compared to the gemcitabine group (7%; 95% CI: 5 to 10). In safety analyses, the combined regimen had a higher incidence of neutropenia (38% vs. 27%), fatigue (17% vs. 7%), and neuropathy (17% vs. 1%) compared to standard therapy.

By Xiaozhou Liu and Adrienne Cheung

More from this author: Nivolumab plus ipilimumab shows promise for metastatic melanoma, Prophylactic platelet transfusions prevent bleeding in hematologic cancers, Azithromycin is not associated with increased cardiovascular death in low-risk groups, Health education module reduces parasitic infections, New chemotherapy precludes the need for radiotherapy in primary mediastinal B-cell lymphoma..

© 2013 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. 

 

Tags: gemcitabinepaclitaxelpancreatic cancer
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