Efficacy and tolerability of second-line <i>nab</i>-paclitaxel and gemcitabine (NG) after failing first-line FOLFIRINOX in patients (pts) with advanced pancreatic cancer (APC): A single-institution experience.
Bibliographic record
Abstract
e15723 Background: APC is incurable and has a poor prognosis. First line chemotherapy options include 5-fluorouracil, irinotecan and oxaliplatin (FOLFIRINOX) or NG. However, the optimal second-line regimen is unclear. In pts who progress on FOLFIRINOX and maintain a good performance status, NG may be a reasonable second line option. As such, we sought to: 1) describe the clinical and pathologic features of pts who received second line NG compared to pts who received second line gemcitabine (GEM) or best supportive care (BSC); 2) Evaluate the toxicity profile of NG in the second line setting; 3) determine whether a survival benefit exists with second line NG. Methods: Pts ≥18 diagnosed with APC from 2012-2016 and treated with palliative chemotherapy at CancerCare Manitoba (CCMB) were identified from the Manitoba Cancer Registry. CCMB pharmacy records identified pts who received FOLFIRINOX followed by second line NG, GEM or BSC. A retrospective analysis was performed to identify pts and treatment characteristics, toxicity, dose reductions, dose delays and survival. Results: 146 pts received first line FOLFIRINOX. Of those who progressed and were offered second line therapy, 30 (50%) received NG, 8 (16%) received GEM and 22 (37%) chose BSC. Median age at diagnosis was 61 (35-84), 47% were female, 73% had metastatic disease and 63% had primaries in the head of pancreas. Grade 3 and 4 neutropenia was more common with NG compared to GEM (27% vs. 6.7%). There were more dose reductions and dose delays with NG compared to GEM (76.7% vs. 25% and 63.3% vs. 12.5% respectively). The median progression free survival was 3.61 months in the NG group, compared with 2.51 months in the GEM group (hazard ratio 2.48; 95% CI 1.08-5.65; P = 0.03). The median OS was 5.69 months in the NG group compared to 3.82 months the GEM group (hazard ratio 2.611; 95% CI, 1.11-6.38). Conclusions: In a select group of pts with APC who progress after first line FOLFIRINOX, there is a role for second line NG. Although many pts required dose reductions and delays, second line NG was associated with a survival benefit compared to GEM, with manageable toxicity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".