FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer
Thierry Conroy,Françoise Desseigne,Marc Ychou,Olivier Bouché,Rosine Guimbaud,Yves Becouarn,Antoine Adenis,Jean-Luc Raoul,Sophie Gourgou-Bourgade,Jaafar Bennouna,Jean-Baptiste Bachet,Faiza Khemissa-Akouz,Denis Péré-Vergé,Catherine Delbaldo,Eric Assenat,Bruno Chauffert,C. Montoto-Grillot,Michel Ducreux +17 more
TLDR
FOLFIRINOX was associated with a survival advantage and had increased toxicity as compared with gemcitabine, and is an option for the treatment of patients with metastatic pancreatic cancer and good performance status.Abstract:
BACKGROUND Data are lacking on the efficacy and safety of a combination chemotherapy regimen consisting of oxaliplatin, irinotecan, fluorouracil, and leucovorin (FOLFIRINOX) as compared with gemcitabine as first-line therapy in patients with metastatic pancreatic cancer. METHODS We randomly assigned 342 patients with an Eastern Cooperative Oncology Group performance status score of 0 or 1 (on a scale of 0 to 5, with higher scores indicating a greater severity of illness) to receive FOLFIRINOX (oxaliplatin, 85 mg per square meter of body-surface area; irinotecan, 180 mg per square meter; leucovorin, 400 mg per square meter; and fluorouracil, 400 mg per square meter given as a bolus followed by 2400 mg per square meter given as a 46-hour continuous infusion, every 2 weeks) or gemcitabine at a dose of 1000 mg per square meter weekly for 7 of 8 weeks and then weekly for 3 of 4 weeks. Six months of chemotherapy were recommended in both groups in patients who had a response. The primary end point was overall survival. RESULTS The median overall survival was 11.1 months in the FOLFIRINOX group as compared with 6.8 months in the gemcitabine group (hazard ratio for death, 0.57; 95% confidence interval [CI], 0.45 to 0.73; P<0.001). Median progression-free survival was 6.4 months in the FOLFIRINOX group and 3.3 months in the gemcitabine group (hazard ratio for disease progression, 0.47; 95% CI, 0.37 to 0.59; P<0.001). The objective response rate was 31.6% in the FOLFIRINOX group versus 9.4% in the gemcitabine group (P<0.001). More adverse events were noted in the FOLFIRINOX group; 5.4% of patients in this group had febrile neutropenia. At 6 months, 31% of the patients in the FOLFIRINOX group had a definitive degradation of the quality of life versus 66% in the gemcitabine group (hazard ratio, 0.47; 95% CI, 0.30 to 0.70; P<0.001). CONCLUSIONS As compared with gemcitabine, FOLFIRINOX was associated with a survival advantage and had increased toxicity. FOLFIRINOX is an option for the treatment of patients with metastatic pancreatic cancer and good performance status. (Funded by the French government and others; ClinicalTrials.gov number, NCT00112658.).read more
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Journal ArticleDOI
Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine
Daniel D. Von Hoff,Thomas J. Ervin,Francis P. Arena,E. Gabriela Chiorean,Jeffrey R. Infante,Malcolm J. Moore,Thomas E. Seay,Sergei Tjulandin,Wen Wee Ma,Mansoor N. Saleh,Marion Harris,Michele Reni,Scot Dowden,Daniel A. Laheru,Nathan Bahary,Ramesh K. Ramanathan,Josep Tabernero,Manuel Hidalgo,David Goldstein,Eric Van Cutsem,Xinyu Wei,Jose Iglesias,Markus F. Renschler +22 more
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Whole genomes redefine the mutational landscape of pancreatic cancer.
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FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer
Thierry Conroy,Pascal Hammel,Mohamed Hebbar,Meher Ben Abdelghani,Alice C. Wei,Jean-Luc Raoul,Laurence Chone,Eric Francois,Pascal Artru,James Joseph Biagi,Thierry Lecomte,Eric Assenat,Roger Faroux,Marc Ychou,Julien Volet,Alain Sauvanet,Gilles Breysacher,Frédéric Di Fiore,Christine Cripps,Petr Kavan,Patrick Texereau,Karine Bouhier-Leporrier,Faiza Khemissa-Akouz,Jean-Louis Legoux,Beata Juzyna,Sophie Gourgou,Christopher J. O'Callaghan,Claire Jouffroy-Zeller,Patrick Rat,David Malka,Florence Castan,Jean-Baptiste Bachet +31 more
TL;DR: Adjuvant therapy with a modified FOLFIRINOX regimen led to significantly longer survival than gemcitabine among patients with resected pancreatic cancer, at the expense of a higher incidence of toxic effects.
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Enzymatic targeting of the stroma ablates physical barriers to treatment of pancreatic ductal adenocarcinoma.
Paolo P. Provenzano,Carlos Cuevas,Amy Chang,Vikas K. Goel,Daniel D. Von Hoff,Sunil R. Hingorani,Sunil R. Hingorani +6 more
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Clinical practice guidelines in oncology
William J. Gradishar,Benjamin O. Anderson,Ron Balassanian,Sarah L. Blair,Harold J. Burstein,Amy E. Cyr,Anthony D. Elias,William B. Farrar,Andres Forero,Sharon H. Giordano,Matthew P. Goetz,Lori J. Goldstein,Steven J. Isakoff,Janice A. Lyons,P. Kelly Marcom,Ingrid A. Mayer,Beryl McCormick,Meena S. Moran,Ruth O'Regan,Sameer A. Patel,Lori J. Pierce,Elizabeth C. Reed,Kilian E. Salerno,Lee S. Schwartzberg,Amy Sitapati,Karen L. Smith,Mary Lou Smith,Hatem Soliman,George Somlo,Melinda L. Telli,John H. Ward,Rashmi Kumar,Dorothy A. Shead +32 more
TL;DR: This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
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