title: Sustained response with gemcitabine plus Nab-paclitaxel after folfirinox failure in metastatic pancreatic cancer: report of an effective new strategy.
abstract: BACKGROUND
  Folfirinox has shown a benefit in terms of survival and quality of life in first line treatment of metastatic pancreatic cancer. However, efficacy of second line chemotherapy after folfirinox is still limited. Gemcitabine plus Nab-paclitaxel have been recently validated as first line treatment with an increased overall survival compared to gemcitabine. This combination has never been studied as second-line after folfirinox.
  
  
  METHODS
  A metastatic pancreatic cancer was diagnosed in a 60-year-old patient with a performance status of 0. After 10 cycles of folfirinox, and an initial objective response, we objectively noted progressive disease according to the RECIST 1.1 criteria together with an increased carbohydrate antigen 19-9. The multidisciplinary team decided to use gemcitabine plus Nab-paclitaxel as second line palliative chemotherapy. After 2 months, we obtained an objective response. After 6 months, this response was maintained with an acceptable tolerability.
  
  
  CONCLUSIONS
  Gemcitabine plus Nab-paclitaxel, as second line palliative chemotherapy, after failure of folfirinox, could be a good strategy for patients with a performance status of 0 and 1. Obviously, this data has to be confirmed in larger patients series and in future comparative clinical studies.
authors.affiliation: Service d'hépatogastro-entérologie et d'oncologie digestive, université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: Alix
authors.initials: A
authors.lastname: Portal
authors.affiliation: Service d'hépatogastro-entérologie et d'oncologie digestive, université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Pernot
authors.affiliation: Service de radiologie, université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Siauve
authors.affiliation: Service d'hépatogastro-entérologie et d'oncologie digestive, université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Landi
authors.affiliation: Service d'hépatogastro-entérologie et d'oncologie digestive, université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Lepère
authors.affiliation: Service d'hépatogastro-entérologie et d'oncologie digestive, université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: Orianne
authors.initials: O
authors.lastname: Colussi
authors.affiliation: Service d'hépatogastro-entérologie et d'oncologie digestive, université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rougier
authors.affiliation: Service d'hépatogastro-entérologie et d'oncologie digestive, université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: Aziz
authors.initials: A
authors.lastname: Zaanan
authors.affiliation: Service de pharmacie, université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Verrière
authors.affiliation: Service d'hépatogastro-entérologie et d'oncologie digestive, université Paris Descartes, Sorbonne Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France. Electronic address: julien.taieb@egp.aphp.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Taieb
mesh_terms: D000418:Albumins / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D018395:CA-19-9 Antigen / Q000097:blood; D002166:Camptothecin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy* / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D000077150:Oxaliplatin; D017239:Paclitaxel / Q000008:administration & dosage*; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017211:Treatment Failure; D000093542:Gemcitabine
chemical_list: C520255:130-nm albumin-bound paclitaxel; D000418:Albumins; D018395:CA-19-9 Antigen; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000077146:Irinotecan; D017239:Paclitaxel; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin; D000093542:Gemcitabine