5-Fluorouracil/Leucovorin Combined with Irinotecan and Oxaliplatin (FOLFIRINOX) as Second-Line Chemotherapy in Patients with Metastatic Pancreatic Adenocarcinoma

• Published in: Oncology Vol. 80; no. 5-6; pp. 301 - 306
• Main Authors: Assaf, Elias, Verlinde-Carvalho, Muriel, Delbaldo, Catherine, Grenier, Julien, Sellam, Zineb, Pouessel, Damien, Bouaita, Linda, Baumgaertner, Isabelle, Sobhani, Iradj, Tayar, Claude, Paul, Muriel, Culine, Stéphane
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2011; S. Karger AG
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Chemotherapy; Chemotherapy, Adjuvant; Clinical Study; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Disease Progression; Drug Administration Schedule; Female; Fluorouracil - administration & dosage; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Leucovorin - administration & dosage; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical Records; Medical sciences; Metastasis; Middle Aged; Neoplasm Staging; Organoplatinum Compounds - administration & dosage; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Retrospective Studies; Treatment Failure; Treatment Outcome; Tumors; Second-line chemotherapy; Irinotecan; FOLFIRINOX; Metastatic pancreatic adenocarcinoma; Oxaliplatin; Fluorouracil; Antineoplastic agent; Calcium folinate; Metastasis; Isomerases; Cancerology; Pancreas cancer; Advanced stage; Second line treatment; Topoisomerase I inhibitor; Pancreatic disease; Platinum II Complexes; Camptothecin derivatives; Human; Enzyme; Fluoropyrimidine derivatives; Transferases; DNA topoisomerase; Enzyme inhibitor; Malignant tumor; Thymidylate synthase; Alkylating agent; Antimetabolic; Methyltransferases; Pyrimidine derivatives; Digestive diseases; Pancreas adenocarcinoma; Cancer
• DOI: 10.1159/000329803
• ISSN: 0030-2414

Background: To evaluate the efficacy and toxicity of irinotecan and oxaliplatin plus 5-fluorouracil (FU) and leucovorin (FOLFIRINOX) as second-line therapy in metastatic pancreatic adenocarcinoma (MPA). Patients and Methods: We retrospectively analyzed the medical records of 27 patients with MPA treated with FOLFIRINOX as second-line therapy between January 2003 and November 2009 in our hospital. The recommended schedule was oxaliplatin 85 mg/m 2 on day 1 + irinotecan 180 mg/m 2 on day 1 + leucovorin 400 mg/m 2 on day 1 followed by FU 400 mg/m 2 as a bolus on day 1 and 2,400 mg/m 2 as 46-hour continuous infusion biweekly. Results: The median age of the 27 patients (13 males and 14 females) was 63 years (45–83). All patients had progressive disease after first-line chemotherapy by gemcitabine. A total of 167 cycles were administered, with a median number of 6 cycles (1–29) per patient. One toxic death occurred (sepsis). Tolerance of treatment was acceptable, and the relative dose density delivered per patient was 92.8% for oxaliplatin, 89.1% for irinotecan and 96.4% for FU. Grade 3–4 neutropenia occurred in 55.6% of the patients, including 1 febrile neutropenia. The other toxicities were manageable. Regarding efficacy, 22 of the 27 patients were evaluable (WHO and RECIST criteria). Five patients had partial responses and 12 stable disease, resulting in an overall disease control rate of 63%. Median time to progression was 5.4 months (0.7–25.48), and median event-free survival was 3 months (0.5–24.9). Median overall survival was 8.5 months (0–26). A clinical benefit was reported for 55% of the patients. Conclusions: These results confirmed the good safety profile and the efficacy of the FOLFIRINOX regimen as second-line treatment of MPA.