MPACT

MPACT randomised 861 patients (431 to nab-paclitaxel plus gemcitabine, 430 to gemcitabine) between 2009 and 2012. Median overall survival was 8.5 against 6.7 months (hazard ratio 0.72, 95 percent confidence interval 0.62 to 0.83; p below 0.001), one-year survival 35 against 22 percent and two-year survival 9 against 4 percent; median progression-free survival 5.5 against 3.7 months (hazard ratio 0.69) and independently reviewed response 23 against 7 percent. Grade 3 or worse neutropenia was 38 against 27 percent, fatigue 17 against 7 percent and peripheral neuropathy 17 against 1 percent, the neuropathy improving to grade 1 or less in a median 29 days after interruption; febrile neutropenia 3 against 1 percent. The long-term update (JNCI 2015) gave 8.7 against 6.6 months with 4 percent of the combination arm alive beyond three years and none on gemcitabine, and found high CA 19-9 and neutrophil-to-lymphocyte ratio prognostic. The FDA approved the combination in September 2013 and the EMA the same year (Abraxane product information); in England NICE TA476 (2017) restricts it to people for whom other combination chemotherapies are unsuitable and who would otherwise have gemcitabine alone. No UK sites took part.