The nab -paclitaxel/gemcitabine regimen for patients with refractory advanced pancreatic adenocarcinoma

Pancreatic cancer (PC) is now the third leading cause of cancer death in the United States with an estimated incidence of 43,920 and 37,390 deaths and is projected to become the second leading cause of cancer death by 2020 (1). Gemcitabine had been the mainstay of chemotherapy for PC for over a decade, as it has demonstrated to be more effective than 5-FU with improved clinical benefit and median survival (2). Erlotinib also showed a statistically significant OS advantage in combination with gemcitabine compared to gemcitabine alone, but the clinical benefit was small and this combination has not been widely accepted (3). More recently two phase III randomized trials have changed practice. The first was the ACCORD/PRODIGE trial that studied the combination of 5-FU, folinic acid (FA), irinotecan and oxaliplatin (FOLFIRINOX); this regimen led to an improvement in objective response rate (RR), progression free survival (PFS) and overall survival (OS) compared to gemcitabine alone (median OS of 11 vs. 6.8 months, P<0.001) (4). The second was the MPACT trial, which investigated the nab-paclitaxel/gemcitabine (AG) combination and also showed an improved RR, OS and PFS compared to gemcitabine alone (median OS of 8.5 vs. 6.7 months respectively, P<0.001) (5). Guidelines now advocate these two regimens as the preferred choices