title: A modified regimen of biweekly gemcitabine and nab-paclitaxel in patients with metastatic pancreatic cancer is both tolerable and effective: a retrospective analysis.
abstract: BACKGROUND
  Treatment with nab-paclitaxel with gemcitabine demonstrates a survival advantage when compared with single-agent gemcitabine. However, the combination is associated with significant toxicities, leading to a high rate of drug discontinuation. We implemented a modified regimen of gemcitabine and nab-paclitaxel (mGNabP) in an attempt to minimize toxicities while maintaining efficacy.
  
  
  METHODS
  A total of 79 evaluable patients with metastatic pancreatic adenocarcinoma (mPC) treated with a modified regimen of gemcitabine (1000 mg/m2) and nab-paclitaxel (125 mg/m2) on days 1, 15 of every 28-day cycle were identified from our prospective database. A total of 57 patients received this regimen as first-line treatment and were evaluated for toxicities, progression-free survival (PFS), and overall survival (OS). Overall, 22 patients with advanced or metastatic PC treated with the modified regimen outside the first-line setting were only evaluated for toxicities.
  
  
  RESULTS
  The median OS and PFS were 10 months [95% confidence interval (CI) 5.9-13 months] and 5.4 months (95% CI 4.1-7.4 months) for patients that received the modified regimen as first-line therapy. Neurotoxicity occurred in 27% with only 1.6% of patients experiencing grade ⩾3 toxicity. The incidence of grade ⩾3 neutropenia was 19%, resulting in growth factor support in 12% of patients. This rate was similar in patients who received the modified regimen for first-line treatment of mPCversusthe overall group.
  
  
  CONCLUSIONS
  A modified regimen of biweekly nab-paclitaxel with gemcitabine is associated with a lower cost, acceptable toxicity profile and appears to be relatively effective in pancreatic cancer. Prospective randomized studies confirming its potential benefits compared with standard weekly mGNabP are warranted.
authors.affiliation: Department of Internal Medicine, Division of Hematology/Medical Oncology, Mayo Clinic, Phoenix, AZ, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Ahn
authors.affiliation: Department of Medical Oncology, Ohio State University Wexner Medical Center, Richard Solove Research Institute and James Cancer Hospital, Columbus, OH, USA.
authors.forename: Kavya
authors.initials: K
authors.lastname: Krishna
authors.affiliation: Department of Pharmacy, Ohio State University Wexner Medical Center, Richard Solove Research Institute and James Cancer Hospital, Columbus, OH, USA.
authors.forename: Marlo
authors.initials: M
authors.lastname: Blazer
authors.affiliation: Department of Pharmacy, Ohio State University Wexner Medical Center, Richard Solove Research Institute and James Cancer Hospital, Columbus, OH, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Reardon
authors.affiliation: Center for Biostatistics, Ohio State University, Columbus, OH, USA.
authors.forename: Lai
authors.initials: L
authors.lastname: Wei
authors.affiliation: Emory Winship Cancer Institute, Department of Hematology and Medical Oncology, Atlanta, GA, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Medical Oncology, Ohio State University Wexner Medical Center, Richard Solove Research Institute and James Cancer Hospital, Columbus, OH, USA.
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Ciombor
authors.affiliation: Department of Medical Oncology, Ohio State University Wexner Medical Center, Richard Solove Research Institute and James Cancer Hospital, Columbus, OH, USA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Noonan
authors.affiliation: Department of Medical Oncology, Ohio State University Wexner Medical Center, Richard Solove Research Institute and James Cancer Hospital, Columbus, OH, USA.
authors.forename: Sameh
authors.initials: S
authors.lastname: Mikhail
authors.affiliation: Department of Internal Medicine, Division of Hematology/Medical Oncology, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: Tanios
authors.initials: T
authors.lastname: Bekaii-Saab
keywords: efficacious; gemcitabine-improved toxicity; modified regimen; nab-paclitaxel; pancreatic cancer