Modified Pancreatic Cancer Regimen Maintains Effectiveness While Reducing Side Effects and Cost


Key Points

  • Treatment with a less-intense regimen of nab-paclitaxel and gemcitabine resulted in an improved toxicity profile for patients with advanced pancreatic cancer.
  • Patients receiving the modified regimen had a median overall survival of 11 months and progression-free survival of 4.8 months, confirming treatment was effective.
  • The modified treatment regimen reduced patient medical costs by $5,500 per month.

A simple change to a two-drug therapy for metastatic pancreatic cancer provides similar cancer control while significantly improving quality of life and reducing the cost of care, according to data reported by researchers at the The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) at the 2015 Gastrointestinal Cancers Symposium (Abstract 366).

In 2013, the U.S. Food and Drug Administration approved the combination of gemcitabine and nab-paclitaxel given three times during a 28-day cycle for the treatment of metastatic pancreatic cancer. The new findings suggest that a modified gemcitabine and nab-paclitaxel (Abraxane) regimen, where the drugs are given every other week rather than weekly, can reduce the toxic side effects of treatment without changing the treatment’s effectiveness.

“The combination of gemcitabine and nab-paclitaxel in pancreatic cancer is one of the most recent advances in pancreatic cancer treatment and has been shown to improve survival when compared to gemcitabine alone,” said first author Kavya Krishna, MD, a hematology oncology fellow at the OSUCCC – James. “But this improved survival comes with increased toxic side effects that can affect quality of life. We sought an alternative regimen that would prolong treatment effectiveness and reduce side effects.”

Study Design and Results

Based on institutional experience and previously published phase III data, the investigators adopted a modified regimen of this two-drug combination for metastatic pancreatic cancer patients treated in Columbus, Ohio.

The study included 69 patients with pancreatic cancer who received the modified regimen of gemcitabine and nab-paclitaxel. Forty-nine patients had previously untreated metastatic pancreatic cancer, and the remaining 20 patients had either failed other chemotherapy treatments or had locally advanced or borderline resectable disease. With a median age of 65, all of the patients were given gemcitabine and nab-paclitaxel on days 1 and 15 of a 28-day treatment cycle.

Overall, less than 2% of patients experienced severe neurologic toxicities (compared with 17% in the previous phase III study); 10% experienced severe low white blood cell counts (compared with 38% in the phase III study); and 8% required growth factor injections the day after chemotherapy treatment to boost production of white blood cells (compared with 26% in the previous study.)

Median overall survival of patients treated with the modified regimen was approximately 11 months, and progression-free survival was 4.8 months, confirming treatment was effective. In addition, the modified treatment regimen reduced patient medical costs by $5,500 per month.

Less-Intense Regimen Reduces Patient Burden

“Pancreatic cancer is an especially difficult diagnosis, so weighing the survival benefit of available treatments against how treatment side effects will impact a patient’s remaining life is a critically important part of the treatment planning process,” Dr. Krishna added.

“Shifting this treatment to every other week gives the immune system time to recover between chemotherapy sessions and less overall toxicity. It also means fewer visits to the infusion center to receive chemotherapy,” said Tanios Bekaii-Saab, MD, Associate Professor and OSUCCC – James Gastrointestinal Oncology Section Chief. “This less-intense, every-other-week treatment approach seems to be effective in treating our patients with metastatic pancreatic cancer while significantly reducing side effects that impact quality of life.”

For full disclosures of the study authors, view the study abstract at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.