Multicenter observational cohort study of second-line chemotherapy after gemcitabine plus nab-paclitaxel for metastatic PDAC

An observational cohort study at 41 centers in Italy compared second-line chemotherapy options after failure of gemcitabine plus nab-paclitaxel for metastatic pancreatic ductal adenocarcinoma (mPDAC). Progression-free survival (PFS) and overall survival (OS) were compared using inverse probability of treatment weighting. Among 704 eligible patients, 56 (8%) received 5FU/LV, 153 (21.7%) FOLFIRI, 209 (29.7%) FOLFOX, 209 (29.7%) NaI-IRI + 5FU/LV, and 77 (10.9%) FOLFIRINOX. FOLFIRINOX was associated with the longest PFS and OS. Median PFS was comparable among doublet regimens. The authors conclude that FOLFIRINOX appears the most effective second-line chemotherapy option for mPDAC after failure of gemcitabine plus nab-paclitaxel.