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Modified FOLFIRINOX for metastatic pancreatic adenocarcinoma after failure of nab-paclitaxel plus gemcitabine.

Abstract

467
Background: Both FOLFIRINOX and Nab-paclitaxel plus Gemcitabine standard treatment in first-line treatment of metastatic pancreatic adenocarcinoma (MPA). It could be of interest to use them consecutively, knowing that there is currently no standard for 2nd line treatments for MPA. The aim of this study was to evaluate the efficacy and tolerability of modified FOLFIRINOX after gemcitabine plus Nab-paclitaxel failure in MPA. Methods: From January 2015 to March 2016, medical records were retrospectively reviewed for consecutive patients receiving modified FOLFIRINOX for a histologically proven MPA after failure of Nab-paclitaxel plus Gemcitabine. Patients were treated with modified FOLFIRINOX every 2 weeks as follows: intravenous oxaliplatin 85 mg/m2, irinotecan 150 mg/m2, 5-FU infusion 2,400 mg/m2 over 46 h, no bolus 5-FU, until disease progression, patient refusal or unacceptable toxicity. Results: Modified FOLFIRINOX was administered to 23 pts. Among these patients, median age was 64 years (range 42.4 - 74.2). 83% of the patients had a PS 0, the primary site of the tumor was the head of the pancreas in 39% of patients, and 26% of patients experienced recurrence after resection. Disease control rate was 66.7% (n = 17) with a 23.8 % (n = 17) objective response rate (RECIST). Within the whole cohort, median PFS was 4.3 months (95% CI: 3.1-5.3) and median overall survival (OS) was 9.3 months (95% CI: 3.8-14.8). Since the start date of first line chemotherapy with Nab-paclitaxel plus Gemcitabine, median OS was 18.8 months (95% CI: 9.6-27.9). No toxic death occured. Grade 3-4 toxicities were reported in 30% of patients and were neutropenia (17%), anemia (8%), cholangitis (8%) and acute kidney injury (4%). Conclusions: Modified FOLFIRINOX seems promising with a manageable toxicity profile after Nab-paclitaxel plus Gemcitabine failure, in selected patients able to receive second line treatment for a MPA. These promising results have now to be confirmed in a phase III randomized trial.

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Journal of Clinical Oncology
Pages: 467

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Published in print: February 01, 2017
Published online: March 21, 2017

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Masato Ozaka
Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan;
Takashi Sasaki
Cancer Institute Hospital of JFCR, Tokyo, Japan;
Seita Kataoka
Cancer Institute Hospital of JFCR, Tokyo, Japan;
Ryo Kanata
Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan;
Kazunaga Ishigaki
Cancer Institute Hospital of JFCR, Tokyo, Japan;
Ikuhiro Yamada
Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan;
Masato Matsuyama
Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan;
Koichi Takano
Cancer Institute Hospital of JFCR, Tokyo, Japan;
Naoki Sasahira
University of Tokyo, Tokyo, Japan
Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Cancer Institute Hospital of JFCR, Tokyo, Japan; Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan; Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; University of Tokyo, Tokyo, Japan

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Masato Ozaka, Takashi Sasaki, Seita Kataoka, Ryo Kanata, Kazunaga Ishigaki, Ikuhiro Yamada, Masato Matsuyama, Koichi Takano, Naoki Sasahira
Journal of Clinical Oncology 2017 35:4_suppl, 467-467

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