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Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer
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Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer
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Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer
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Journal Article
Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer
2016
Overview
Background:
Modifications of FOLFIRINOX are widely used despite the absence of prospective data validating efficacy in metastatic disease (metastatic pancreatic cancer (MPC)) or locally advanced pancreatic cancer (LAPC). We conducted a multicentre phase II study of modified FOLFIRINOX in advanced pancreatic cancer to assess the impact of dose attenuation in MPC and efficacy in LAPC.
Methods:
Patients with untreated MPC or LAPC received modified FOLFIRINOX (irinotecan and bolus 5-fluorouracil reduced by 25%). Adverse events (AEs) were compared with full-dose FOLFIRINOX. Response rate (RR), median progression-free survival (PFS) and median overall survival (OS) were determined.
Results:
In total, 31 and 44 patients with LAPC and MPC were enrolled, respectively. In MPC, efficacy of modified FOLFIRINOX was comparable with FOLFIRINOX with RR 35.1%, OS 10.2 months (95% CI 7.65–14.32) and PFS 6.1 months (95% CI 5.19–8.31). In LAPC, efficacy was notable with RR 17.2%, resection rate 41.9%, PFS 17.8 months (95% CI 11.0–23.9) and OS 26.6 months (95% CI 16.7, NA). Neutropenia (
P
<0.0001), vomiting (
P
<0.001) and fatigue (
P
=0.01) were significantly decreased. [
18
F]-Fluorodeoxyglucose positron emission tomography imaging response did not correlate with PFS or OS.
Conclusions:
In this first prospective study of modified FOLFIRINOX in MPC and LAPC, we observed decreased AEs compared with historical control patients. In MPC, the efficacy appears comparable with FOLFIRINOX. In LAPC, PFS and OS were prolonged and support the continued use of FOLFIRINOX in this setting.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ Adenocarcinoma - drug therapy
/ Adult
/ Aged
/ Antineoplastic Combined Chemotherapy Protocols - therapeutic use
/ Biomedical and Life Sciences
/ Camptothecin - administration & dosage
/ Camptothecin - analogs & derivatives
/ Female
/ Fluorouracil - administration & dosage
/ Humans
/ Leucovorin - administration & dosage
/ Liver Neoplasms - drug therapy
/ Lung Neoplasms - drug therapy
/ Male
/ Oncology
/ Organoplatinum Compounds - administration & dosage
/ Pancreatic Neoplasms - drug therapy
/ Pancreatic Neoplasms - mortality
/ Pancreatic Neoplasms - pathology
/ Peritoneal Neoplasms - drug therapy
/ Peritoneal Neoplasms - mortality
