Work

Relative dose intensity of gemcitabine-nab-paclitaxel combination as second-line or more in locally advanced or metastatic pancreatic adenocarcinoma

Year: 2025

Type: article

Abstract: • Relative dose intensity (RDI) of gemzar-nab-paclitaxel (GNP) has not been reported in second line and more in advanced pancreatic carcinoma. • The RDI is relatively low with 50 % of patients who received GNP at a RDI ≥70 % during the first months of treatment resulting of treatment schedule modification in two third of cases and a full dose in only 15 %. • There was no significant difference in prognosis between RDI <70 % and ≥70 % supporting that alternative GNP regimens may be of interest in that setting. Gemcitabine-nab-paclitaxel (GNP) is widely used in treating advanced or metastatic pancreatic adenocarcinoma (a/mPA), but no data are available regarding its relative dose intensity (RDI) beyond the first line. To assess the impact of the RDI of GNP as second-line or greater therapy (L2+) for a/mPA. Patients with a/mPA undergoing L2+ treatment were retrospectively included. The RDI was analysed from the start of GNP to the first CT scan. Overall survival (OS), progression-free survival (PFS) and toxicity were analysed according to the RDI at a predefined threshold of 70 %. A total of 116 patients were included, with a median RDI of 70 % (range, 20 %-114 %). There was no significant difference in OS or PFS between RDI<70 % and ≥70 %, with median of 7.0 and 8.1 months (adjusted HR = 1.35; CI95 % [0.89–2.05]; p = 0.2) and 3.1 vs 3.4 months (adjusted HR = 1.36; CI95 % [0.91–2.05]; p = 0.14), respectively. Grade ≥3 toxicities were more common in RDI <70 % as compared to RDI ≥70 % (56.9 % vs. 37.9 %, p = 0.04) and responsible for more GNP dose reductions (67.7 % vs. 50 %, p = 0.13) and schedule modifications (72.4 % vs. 48.2 %, p = 0.008). Our results suggest that the level of GNP exposure, at a predefined RDI threshold of 70 %, had no significant effect on survival in our patients treated in L2+ for a/mPA. Alternative GNP regimens may be evaluated in patients undergoing L2+ treatment for a/mPA.

Source: Clinics and Research in Hepatology and Gastroenterology

DOI: 10.1016/j.clinre.2025.102583