Comparison Of Folfirinox And Gemcitabine With Nab-Paclitaxel In Metastatic Pancreatic Cancer: Using Korean Pancreatic Cancer (K-Pac) Registry.

e15762 Background: Although FOLFIRINOX and gemcitabine with nab-paclitaxel (GNP) are widely used in metastatic pancreatic cancer (MPC), the multi-center study comparing two regimens is rare. Recently, a multi-center, web-based registry for pancreatic cancer (K-PaC, Korean pancreatic cancer) was firstly launched in South Korea. We aimed to compare the clinical outcomes for FOLFIRINOX and GNP in MPC patients using K-PaC registry. Methods: In the K-PaC registry, we constructed the web-based database of anonymized 3,748 patients with histologically-proven pancreatic ductal adenocarcinoma. For this study, MPC patients who have received first-line FOLFIRINOX or GNP were enrolled. The baseline characteristics, overall survival (OS), grade III-IV toxicity, and other subgroup characteristics were analyzed. Results: From 2011 to 2017, a total of 413 (FOLFIRINOX 231 vs. GNP 182: with the same order below) patients met the eligible criteria. Median age was 63 year (60 vs. 68) and male were 46% (51% vs. 39%). Origins of tumor were head (41%), body (25%), and tail (34%). Major metastatic sites were liver (62%), peritoneum (32%), lung (18%), and others (34%), including multiple metastases. Median OS was 11.6 month (11.3 vs. 12.4, hazard ratio [HR] 0.91, confidence interval [CI] 0.71–1.16). The major hematologic toxicity was 32% of neutropenia (37% vs. 23% with P-value 0.116) and 12% of febrile neutropenia (16% vs. 10% with P-value 0.172). The major non-hematologic toxicity was 33% of fatigue (29% vs. 37% with P-value 0.455) and 28% of vomiting (27% vs. 29% with P-value 0.516). According to metastatic site, median OS by agents (months, FOLFIRINOX vs. GNP) were as follows: 9.5 vs. 10.2 with HR 0.898, CI 0.66–1.22 in liver; 11.8 vs. 12.5 with HR 0.90, CI 0.61–1.33 in lung; 9.1 vs. 12.6 with HR 0.94, HR 0.70–1.19 in peritoneal seeding. According to the sequential treatment, median OS of 1 st -line FOLFIRINOX followed by GNP group (n = 53) was 11.2 month and that of 1 st -line GNP followed by FOLFIRINOX group (n = 43) was 12.4 month (HR 0.82, CI 0.68–1.18). Conclusions: In this study using K-PaC registry in Korea, FOLFIRINOX and GNP showed comparable efficacy and toxicity. In the subgroup analysis, sequential treatment did not showed significant difference, but GNP showed a better trend in the group of peritoneal seeding.