Inclusion of the FOLFIRINOX regimen in the treatment algorithm for metastatic pancreatic cancer – first experience

Czech version

Authors: M. Vočka; L. Petruželka
Authors‘ workplace: Onkologická klinika 1. LF UK a ÚVN – VFN Praha
Published in: Gastroent Hepatol 2014; 68(5): 436-440
Category: Gastrointestinal Oncology: Original Article
doi: https://doi.org/10.14735/amgh2014436

Overview

Pancreatic cancer represents ~ 2% of all cancers (6% of all deaths from cancer). The most common histological type (> 90%) are ductal adenocarcinomas. This type of cancer has a strong tendency for local invasion and distant metastases. Therapeutic results in all stages of the disease are worse than in all other solid tumors.

Methods:
The study involved a total of 23 patients with locally advanced and metastatic pancreatic cancer at the Oncology Clinic of the 1st Faculty of Medicine and General Teaching Hospital in Prague between January 2013 and July 2014. All patients underwent treatment with FOLFIRINOX regimen every two weeks (oxaliplatin 85 mg/m², irinotecan180 mg/m², leucovorine 400 mg/m², bolus of 5-fluorouracile 400 mg/m² and continual infusion of 5-fluorouracile 2,400 mg/m² for 46 hours) with a good performance status (PS 0–1) in the first or second line therapy. The antitumor efficacy (number of objective responses, time to progression and overall survival) and adverse events were monitored.

Results:
The median time to progression was 7.5 months, with one complete remission and six partial remissions according to RECIST. The median number of administered cycles was 10 (from 1 to 17). Irinotecan was reduced in six patients because of toxicity (irinotecan administration had to be discontinued permanently in three patients), oxaliplatin was reduced in five patients (it had to be discontinued permanently in three patients). The median overall survival reached 15.1 months from the diagnosis of inoperable locally advanced or generalized tumor.

Conclusion:
In patients with advanced pancreatic cancer with a good performance status (0–1) FOLFIRINOX may significantly increase the time to progression and overall survival with a good quality of life.

Key words:
pancreatic cancer – FOLFIRINOX – efficiency – toxicity

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
29. 8. 2014

Accepted:
6. 10. 2014

Sources

1. Informační systém pro analytické zpracování dat Národního onkologického registru. Dostupné z: www.svod.cz.

2. Cowgill SM, Muscarella P. The genetics of pancreatic cancer. Am J Surg 2003; 186(3): 279–286.

3. Hidalgo M. Pancreatic cancer. N Engl J Med 2010; 362(17): 1605–1617. doi: 10.1056/NEJMra0901557.

4. Verdecchia A, Francisci S, Brenner H et al. Recent cancer survival in Europe: a 2000–02 period analysis of EUROCARE-4 data. Lancet Oncol 2007; 8(9): 784–796.

5. Roazzi P, Capocaccia R, Santaquilani M et al. Electronic availability of EUROCARE-3 data: a tool for further analysis. Ann Oncol 2003; 14 (Suppl 5): 150–155.

6. Glimelius B, Hoffman K, Sjödén PO et al. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol 1996; 7(6): 593–600.

7. Burris HA 3rd, Moore MJ, Andersen J et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997; 15(6): 2403–2413.

8. Conroy T, Desseigne F, Ychou M et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011; 364(19): 1817–1825. doi: 10.1056/NEJMoa1011923.

9. Von Hoff DD, Ervin T, Arena FP et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 2013; 369(18): 1691–1703. doi: 10.1056/NEJMoa1304369.

10. Gunturu KS, Yao X, Cong X et al. FOLFIRINOX for locally advanced and metastatic pancreatic cancer: single institution retrospective review of efficacy and toxicity. Med Oncol 2013; 30(1): 361. doi: 10.1007/s12032-012-0361-2.