Palliative systemic treatment of patients with pancreatic cancer — should reimbursement of nab-paclitaxel change the current management paradigm?

Abstract

Pancreatic cancer is associated with poor prognosis. In the majority of patients the disease is diagnosed at an inoperable stage, so palliative chemotherapy is the only possible management. In a highly clinically and biochemically selected subpopulation two chemotherapy multi-drug schemes: FOLFIRINOX regimen and combination of nab-paclitaxel with gemcitabine, are more effective than gemcitabine alone, being the current standard of treatment. As there is a lack of direct comparison between doublet and triplet chemotherapies and the prognosis of patients enrolled to ACCORD 11 and MPACT clinical trials is similar, an attempt at indirect analysis was undertaken. It seems that chemotherapy with the use of FOLFIRINOX regimen prolongs overall survival significantly more and mainly has a beneficial impact on quality of life. In the authors’ opinion, the possibilities of using chemotherapy containing nab-paclitaxel and gemcitabine are quite limited. In patients with worse performance status monotherapy with gemcitabine or best supportive care should remain a standard of management.