期刊论文详细信息
The oncologist
FOLFIRINOX De-Escalation in Advanced Pancreatic Cancer: A Multicenter Real-Life Study
article
Hortense Chevalier1  Cindy Neuzillet2  Christophe Borg4  Anthony Turpin2  Angélique Vienot4  Astrid Lièvre7  Julien Edeline8  Farid El Hajbi1  Charlotte Peugniez1,10  Dewi Vernerey1,11  Aurélia Meurisse1,11  Pascal Hammel2 
[1] Department of Medical Oncology, Oscar Lambret Center;Oncology Multidisciplinary Research Group (GERCOR);Department of Medical Oncology, Curie Institute, Versailles Saint-Quentin University;Department of Medical Oncology, Besançon University Hospital;Department of Medical Oncology, Lille University Hospital;Institut Pasteur de Lille, Centre Hospitalier Universitaire (CHU) Lille, Lille University;Unité Mixte de Recherche (UMR)_S 1242, Department of Gastroenterology, Rennes University Hospital;Oncology Department, Cancer Institute Eugène Marquis, Rennes 1 University;Institut National de la Recherche Agronomique (INRA), Rennes 1 University;Department of Medical Oncology, Saint Vincent de Paul Hospital;Methodological and Quality of Life in Oncology Unit, Besançon University Hospital;Department of Digestive Oncology, Beaujon University Hospital;University Paris 7
关键词: FOLFIRINOX;    Maintenance treatment;    Advanced pancreatic cancer;    Real-life study;    Quality of life;   
DOI  :  10.1634/theoncologist.2020-0577
学科分类:地质学
来源: AlphaMed Press Incorporated
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【 摘 要 】

Background Our study describes the feasibility and efficacy of a first-line FOLFIRINOX (5-fluorouracil [5FU], folinic acid, irinotecan, and oxaliplatin) induction chemotherapy (CT) followed by de-escalation as a maintenance strategy for advanced pancreatic cancer. Materials and Methods This multicenter retrospective study was conducted from January 2011 to December 2018. FOLFIRINOX de-escalation was defined as stopping oxaliplatin and/or irinotecan after at least four cycles of FOLFIRINOX, without evidence of disease progression. Maintenance schedules were fluoropyrimidine monotherapy (intravenous or oral [capecitabine]), FOLFOX (5FU, oxaliplatin), or FOLFIRI (5FU, irinotecan). Primary endpoint was overall survival (OS). Secondary endpoints were first progression-free survival (PFS1), second progression-free survival (PFS2), and toxicity. Results Among 321 patients treated with FOLFIRINOX, 147 (45.8%) were included. Median OS was 16.1 months (95% confidence interval [CI], 13.7–20.3) and median PFS1 was 9.4 months (95% CI, 8.5–10.4). The preferred maintenance regimen was FOLFIRI in 66 (45%) patients versus 5FU monotherapy in 52 (35%) and FOLFOX in 25 (17%) patients. Among 118 patients who received maintenance CT with FOLFIRI or 5FU, there was no difference in PFS1 (median, 9.0 vs. 10.1 months, respectively; p = .33) or OS (median, 16.6 vs. 18.7 months; p = .86) between the two maintenance regimens. Reintroduction of FOLFIRINOX was performed in 20.2% of patients, with a median PFS2 of 2.8 months (95% CI, 2.0–22.3). The rates of grade 3–4 toxicity were significantly higher with FOLFIRI maintenance CT than with 5FU (41% vs. 22%; p = .03), especially for neuropathy (73% vs. 9%). Conclusion 5FU monotherapy maintenance appeared to be as effective as FOLFIRI, in a FOLFIRINOX de-escalation strategy, which is largely used in France. Implications for Practice FOLFIRINOX de-escalation and maintenance is a feasible strategy in advanced pancreatic cancer that decreases chemotherapy toxicity to improve both survival and quality of life. Survivals in patients with maintenance therapy are clinically meaningful. Fluoropyrimidine monotherapy maintenance seems to be as efficient as FOLFIRI and should be a reference arm in future pancreatic cancer maintenance trials.

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