FIrst Line Treatment of Metastatic Pancreatic Cancer: Sequential Nab-paclitaxel + Gemcitabine/FOLFIRI.3 VS Nab-paclitaxel + Gemcitabine

Inclusion Criteria

• •Histological or cytological confirmation of pancreatic adenocarcinoma
• •Distant metastatic disease
• •Scan (or MRI if scanner contraindicated) completed within 3 weeks of the start of treatment
• •At least one lesion measurable by RECIST v1.1 criteria
• •Life expectancy\> 3 months
• •No previous chemotherapy (adjuvant chemotherapy with gemcitabine authorised if administered more than 6 months prior to inclusion)
• •No previous radiotherapy (unless at least one measurable target lesion outside the irradiation zone)
• •Pain must be monitored before inclusion
• •18 years \< age \< 75
• •Performance status: WHO \< 2
• •ANC ≥ 1500/mm3, platelets ≥ 100 000/mm3, haemoglobin ≥ 9 g/dL
• •ASAT (SGOT), ALAT (SGPT) ≤ 2.5 x ULN or ≤ 5 x ULN if liver metastases found
• •Bilirubin ≤ 1.5 x ULN (patients drained by retrograde technique are includable), creatinine \< 120 μmol/L, or MDRD creatinine clearance \> 60 mL/min
• •Women of childbearing age must have a negative pregnancy test (β HCG) before starting treatment
• •Women of childbearing age as well as men (who have sexual intercourse with women of childbearing age) must agree to use effective contraception without interruption for the duration of treatment and 6 months after the administration of the last treatment dose
• •Patient affiliated to the social security scheme
• •Patient information and signature of informed consent