Pancreatic Cancer
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Should gemcitabine plus nab-paclitaxel be used in the adjuvant pancreatic cancer setting?

The randomized phase 3 APACT trial was a well-designed adjuvant trial that evaluated the addition of nab-paclitaxel (Abraxane, Celgene) to gemcitabine — the combination was planned based upon the positive results of the MPACT trial in the metastatic setting. Interestingly, around the same time as the MPACT trial, FOLFIRINOX also showed improved OS in the metastatic setting compared with single-agent gemcitabine. Although median survival with FOLFIRINOX appeared to be numerically superior than with gemcitabine and nab-paclitaxel, subsequent real-world analyses indicated no significant differences in OS or time to treatment failure between the two regimens. It is therefore surprising that although the adjuvant FOLFIRINOX study was positive, the adjuvant gemcitabine and nab-paclitaxel trial was not.