5-Fluorouracil/L-Leucovorin Plus Oxaliplatin (FOLFOX) Regimen as Salvage Chemotherapy for Patients with Unresectable Pancreatic Cancer Receiving Gemcitabine and Nab-Paclitaxel and 5-Fluorouracil/L-Leucovorin Plus Nanoliposomal Irinotecan: Preliminary Results from Clinical Practice

Abstract

Salvage chemotherapy for patients with unresectable pancreatic cancer (UR-PC) who have been treated with gemcitabine and nab-paclitaxel (GnP), and 5-fluorouracil (5-FU)/l-leucovorin (LV) plus nanoliposomal irinotecan (nal-IRI), has not been fully established. We retrospectively reviewed data from 17 patients with UR-PC who initiated 5-FU/l-LV plus oxaliplatin (FOLFOX) as salvage chemotherapy at our hospital between June 2020 and August 2021, after treatment with GnP and 5-FU/LV plus nal-IRI. The primary endpoint was tumor response. The secondary endpoints were progression-free survival (PFS) and adverse events (AEs). The response and disease control rates were 5.9% (1/17) and 17.6% (3/17), respectively. The median PFS was 1.8 months (range: 0.4–5.2 months). Eight patients (47.1%) experienced grade 3 nonhematologic AEs, while none experienced grade 3 hematologic AEs. Two patients with controlled disease had homologous recombination deficiency (HRD)-associated gene mutations in cancer panel testing. The FOLFOX regimen benefit for UR-PC patients treated with GnP and 5-FU/LV plus nal-IRI may be limited to patients with HRD-associated gene mutations.

FOLFOX regimen after failure of fluorouracil and leucovorin plus nanoliposomal-irinotecan therapy for advanced pancreatic cancer: a retrospective observational study

“…Hence, it is reasonable that the median PFS in our study was worse than that in studies on second-line treatment. Yamai et al also evaluated the efficacy of the FOLFOX regimen as salvage treatment after GEM plus nab-PTX and 5-FU/LV + nal-IRI [ 14 ]; although the sample size was 17, which was smaller than that in our study, the results are consistent with those of our study.…”

“…BRCA mutation status was not examined in nine patients in this study because these patients were diagnosed with contraindications for FOLFIRINOX. The prevalence of germline BRCA mutation was reported to be 4–7% [ 27 – 29 ] and that of HRD gene mutations, such as ATM, PALB2, CHEK2, and RAD51C, may be higher [ 14 , 30 ]. HRD gene mutation was reported to be predictive of the FOLFOX regimen [ 14 ].…”

FOLFOX regimen after failure of fluorouracil and leucovorin plus nanoliposomal-irinotecan therapy for advanced pancreatic cancer: A retrospective observational study

“…Hence, it is reasonable that the median PFS in our study was worse than that in studies on second-line treatment. Yamai et al also evaluated the e cacy of the FOLFOX regimen as salvage treatment after GEM plus nab-PTX and 5-FU/LV + nal-IRI [14]; although the sample size was 17, which was smaller than that in our study, the results are consistent with those of our study.…”

“…The prevalence of germline BRCA mutation was reported to be 4-7% [27][28][29] and that of HRD gene mutations, such as ATM, PALB2, CHEK2, and RAD51C, may be higher [14,30]. HRD gene mutation was reported to be predictive of the FOLFOX regimen [14]. Next-generation sequencing using a cancer genome panel would aid in selecting patients who may be candidates for FOLFOX in the third or later lines of advanced PDAC.…”

“…BRCA mutation status was not examined in nine patients in this study because these patients were diagnosed with contraindications for FOLFIRINOX. The prevalence of germline BRCA mutation was reported to be 4-7% [27][28][29] and that of HRD gene mutations, such as ATM, PALB2, CHEK2, and RAD51C, may be higher [14,30]. HRD gene mutation was reported to be predictive of the FOLFOX regimen [14].…”