TY - JOUR
T1 - Modified FOLFIRINOX regimen with improved safety and maintained efficacy in pancreatic adenocarcinoma
AU - Mahaseth, Hemchandra
AU - Brutcher, Edith
AU - Kauh, John
AU - Hawk, Natalyn
AU - Kim, Sungjin
AU - Chen, Zhengjia
AU - Kooby, David A.
AU - Maithel, Shishir K.
AU - Landry, Jerome
AU - El-Rayes, Bassel F.
PY - 2013/11
Y1 - 2013/11
N2 - OBJECTIVES: FOLFIRINOX (5-fluorouracil [5-FU], oxaliplatin, and irinotecan) as compared with gemcitabine in pancreatic cancer (PC) has superior activity and increased toxicity. The bolus 5-FU contributes to the toxicity. We hypothesized that the elimination of bolus 5-FU and use of hematopoietic growth factor will improve the safety profile without compromising the activity of FOLFIRINOX. METHODS: Sixty patients with PC treated with modified FOLFIRINOX (no bolus 5-FU) were reviewed. Patients were divided into metastatic or nonmetastatic (locally advanced or borderline resectable) disease. Toxicity, response rate, progression-free survival, and overall survival were evaluated. RESULTS: Nonmetastatic and metastatic disease were present in 24 (40%) and 36 (60%) patients, respectively. The incidence of grade 4 neutropenia, grade 3/4 diarrhea, and fatigue were 3%, 13%, and 13%, respectively. Response rate was 30%. The median progression-free survival for nonmetastatic disease was 13.7 months (95% confidence interval [CI], 9.6-24.6 months), and that for metastatic disease was 8.5 months (95% CI, 3.7-11.0 months), respectively. The median overall survival for nonmetastatic disease was 17.8 months (95% CI, 9.9 months to not estimable), and that for metastatic disease was and 9.0 months (95% CI, 7.1 months to not estimable), respectively. CONCLUSIONS: Modified FOLFIRINOX has an improved safety profile with maintained efficacy in metastatic PC. Modified FOLFIRINOX has promising activity in nonmetastatic disease.
AB - OBJECTIVES: FOLFIRINOX (5-fluorouracil [5-FU], oxaliplatin, and irinotecan) as compared with gemcitabine in pancreatic cancer (PC) has superior activity and increased toxicity. The bolus 5-FU contributes to the toxicity. We hypothesized that the elimination of bolus 5-FU and use of hematopoietic growth factor will improve the safety profile without compromising the activity of FOLFIRINOX. METHODS: Sixty patients with PC treated with modified FOLFIRINOX (no bolus 5-FU) were reviewed. Patients were divided into metastatic or nonmetastatic (locally advanced or borderline resectable) disease. Toxicity, response rate, progression-free survival, and overall survival were evaluated. RESULTS: Nonmetastatic and metastatic disease were present in 24 (40%) and 36 (60%) patients, respectively. The incidence of grade 4 neutropenia, grade 3/4 diarrhea, and fatigue were 3%, 13%, and 13%, respectively. Response rate was 30%. The median progression-free survival for nonmetastatic disease was 13.7 months (95% confidence interval [CI], 9.6-24.6 months), and that for metastatic disease was 8.5 months (95% CI, 3.7-11.0 months), respectively. The median overall survival for nonmetastatic disease was 17.8 months (95% CI, 9.9 months to not estimable), and that for metastatic disease was and 9.0 months (95% CI, 7.1 months to not estimable), respectively. CONCLUSIONS: Modified FOLFIRINOX has an improved safety profile with maintained efficacy in metastatic PC. Modified FOLFIRINOX has promising activity in nonmetastatic disease.
KW - bolus 5-FU
KW - borderline resectable
KW - FOLFIRINOX
KW - locally advanced
KW - pancreas cancer
KW - toxicity
UR - http://www.scopus.com/inward/record.url?scp=84887272144&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84887272144&partnerID=8YFLogxK
U2 - 10.1097/MPA.0b013e31829e2006
DO - 10.1097/MPA.0b013e31829e2006
M3 - Article
C2 - 24152956
AN - SCOPUS:84887272144
SN - 0885-3177
VL - 42
SP - 1311
EP - 1315
JO - Pancreas
JF - Pancreas
IS - 8
ER -