# MPACT (Von Hoff 2013): nab-paclitaxel plus gemcitabine for metastatic pancreatic cancer

Source: https://onco.cc/key-papers/paper-mpact-nab-paclitaxel-gemcitabine-nejm-2013/  
OnCo record `paper-mpact-nab-paclitaxel-gemcitabine-nejm-2013` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding albumin-bound paclitaxel to gemcitabine prolonged survival in metastatic pancreatic cancer in a large international trial, giving patients who are not fit enough for FOLFIRINOX a second effective first-line option.

## Summary

MPACT randomised 861 patients with untreated metastatic pancreatic adenocarcinoma to nab-paclitaxel plus gemcitabine or gemcitabine alone. The combination improved overall survival, progression-free survival and response rate, with more neutropenia, fatigue and peripheral neuropathy that was usually reversible on dose reduction. Because it accepted patients up to performance status 2 and was less toxic than FOLFIRINOX, it became the alternative first-line standard and the backbone for many later combination trials.

## Fields

- Kind: Key paper
- Last checked: 2026-09-08
- Journal: New England Journal of Medicine
- Year: 2013
- DOI: 10.1056/NEJMoa1304369
- Authors: Von Hoff DD, Ervin T, Arena FP, et al.
- Findings: 861 patients with untreated metastatic pancreatic cancer; nab-paclitaxel plus gemcitabine vs gemcitabine.; Median overall survival 8.5 vs 6.7 months, hazard ratio 0.72.; Median progression-free survival 5.5 vs 3.7 months, hazard ratio 0.69; response rate 23% vs 7%.; Grade 3 or higher neutropenia 38% vs 27% and peripheral neuropathy 17% vs 1%.
- What it means: With FOLFIRINOX this trial defined the two chemotherapy standards for metastatic pancreatic cancer that still apply, and the gemcitabine and nab-paclitaxel backbone is the comparator in most current first-line pancreatic trials.
- Caveats: Open-label design.; The survival gain is measured in months and the disease remains one of the most lethal.; Cross-trial comparison with FOLFIRINOX is unreliable; the populations differed in fitness.

## Sources

- Full text (DOI): https://doi.org/10.1056/NEJMoa1304369
- ClinicalTrials.gov NCT00844649: https://clinicaltrials.gov/study/NCT00844649

## Connected records

- key papers: [Burris 1997: gemcitabine becomes the first standard treatment for advanced pancreatic cancer](https://onco.cc/key-papers/paper-burris-gemcitabine-pancreatic-jco-1997/), [Conroy 2011: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer (PRODIGE 4/ACCORD 11)](https://onco.cc/key-papers/paper-conroy-folfirinox-pancreatic-nejm-2011/), [Randomized Phase III Trial of Pegvorhyaluronidase Alfa With Nab-Paclitaxel Plus Gemcitabine for Patients With Hyaluronan-High Metastatic Pancreatic Adenocarcinoma](https://onco.cc/key-papers/paper-halo-301-pegvorhyaluronidase-jco-2020/)
- cancers: [Locally advanced unresectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/locally-advanced-pdac/), [Metastatic pancreatic ductal adenocarcinoma](https://onco.cc/cancers/metastatic-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- drugs: [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/)
- terms: [Overall survival (OS)](https://onco.cc/terms/os/), [Progression-free survival (PFS)](https://onco.cc/terms/pfs/)
- people: [Daniel D. Von Hoff](https://onco.cc/people/daniel-von-hoff/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)

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