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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.
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.
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.
The definitive negative result for first-generation stromal targeting: a biomarker-selected population, a drug that did what it was designed to do to the matrix, and no survival benefit; the stroma ideas on this page start from here.
This trial introduced a patient-centred composite endpoint and a drug that remained the backbone of pancreatic cancer treatment for a generation. Its small survival gain also shows how low the bar was, which is the context for the FOLFIRINOX and MPACT trials that followed.
Shares Burris 1997: gemcitabine becomes the first standard treatment for advanced pancreatic cancer, Conroy 2011: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer (PRODIGE 4/ACCORD 11), Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma.
Shares Daniel D. Von Hoff, Conroy 2011: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer (PRODIGE 4/ACCORD 11), Overall survival (OS), Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question.
Shares Gemcitabine + nab-paclitaxel, Gemcitabine, Metastatic pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma.
Shares Progression-free survival (PFS), Overall survival (OS), Gemcitabine, Metastatic pancreatic ductal adenocarcinoma.
Shares Daniel D. Von Hoff, Gemcitabine + nab-paclitaxel, Gemcitabine, Metastatic pancreatic ductal adenocarcinoma.
Shares Daniel D. Von Hoff, Pancreatic ductal adenocarcinoma.
Shares Gemcitabine + nab-paclitaxel, Locally advanced unresectable pancreatic ductal adenocarcinoma, Metastatic pancreatic ductal adenocarcinoma.
Shares Gemcitabine + nab-paclitaxel, Locally advanced unresectable pancreatic ductal adenocarcinoma, Metastatic pancreatic ductal adenocarcinoma.