Nab-paclitaxel and gemcitabine for the treatment of patients with metastatic pancreatic cancer

Abstract

Adenocarcinoma of the pancreas or pancreatic cancer as we will refer to it here, is a cancer of poor prognosis with a high mortality, particularly in the advanced or metastatic setting. Until 2011 and the Phase III results of FOLFIRINOX, standard treatment options were limited to gemcitabine. Combination therapy had shown either a lack of or very limited improvement versus monotherapy with gemcitabine. With the positive results of the MPACT study in 2013 showing improved survival with nab-paclitaxel plus gemcitabine combination therapy, there are now more options for oncologists to treat patients with advanced pancreatic cancer. This paper will highlight the Phase I/II and Phase III trials of nab-paclitaxel plus gemcitabine along with discussing their biology and further possible development in treating patients with pancreatic cancer.

Keywords::

• 5-fluorouracil
• FOLFIRINOX
• gemcitabine
• nab-paclitaxel
• pancreatic adenocarcinoma
• pancreatic cancer

Financial & competing interests disclosure

E Borazanci and DD Von Hoff report personal fees from Celgene, outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Pancreatic adenocarcinoma, or pancreatic cancer, is a cancer with a very poor prognosis, with 5-year survival in patients with metastatic disease to be approximately 2% and a 6-month median overall survival (OS). Based on recent work, there is a perception that this is changing.

• Gemcitabine monotherapy was the standard treatment for patients with advanced pancreatic cancer until 2011 when the results of the Phase III study of FOLFIRINOX published and improved survival was seen.

• The clinical trials of nab-paclitaxel plus gemcitabine showed significant improvement in progression-free survival and OS compared with gemcitabine in patients with advanced pancreatic cancer. This has given us another possible standard of care for patients with advanced pancreatic cancer.

• Further trials are under way examining nab-paclitaxel plus gemcitabine in the neoadjuvant and adjuvant setting of pancreas cancer.

• Better understanding of the molecular biology of pancreatic cancer growth may lead to further improvements in OS in patients with advanced pancreatic cancer.