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