Nabbing the spotlight.

Though early identification and outright cures remain elusive, outcomes for pancreatic cancer are nevertheless creeping ever so slightly towards longer survival times. The paradigm has been to first test out new regimens in metastatic disease with only the successes moving to earlier stage disease in patients with more to lose. That was the case with the two most popular regimens, gem/nab-paclitaxel (aka Abraxane) and FOLFIRINOX, whose use in the adjuvant setting was extrapolated until only recently with the unprecedented results of PRODIGE 24. The newest regimen to show promise in the metastatic setting is brought to us by the Italians in the phase 2 PACT-19 trial. 83 patients with untreated metastatic pancreatic adenocarcinoma were randomized to gem/Abraxane +/- cisplatin with daily Xeloda (PAXG for short) with a primary endpoint of progression-free survival (PFS). We promised promising and here it is: PFS at 6 months was 31/42 (74%) with the addition of cisplatin/Xeloda and 19/41 (46%) without. TBL: It might be a while until PAXG gets a shot at taking on mFOLFIRINOX in a phase 3 trial for pancreatic cancer, but it just may be the next new idea to push survival out even further. | Reni, Gastroenterol Hepatol 2018