A single-center experience of modified FOLFOX-6 in locally advanced and metastatic pancreatic adenocarcinomas.

Abstract

303 Background: Pancreatic adenocarcinoma has historically been as a disease with a poor prognosis with a 5 year survival rate of about 6%. The recently published ACCORD 11 trial demonstrated an improved overall survival utilizing FOLFIRINOX versus gemcitabine which has been the standard of care. However, FOLFIRINOX was associated with a significantly higher incidence of both hematologic and nonhematologic toxicities at the expense of increased toxicity. At our institution, FOLFIRINOX has been found to have a very similar toxicity profile with a significant impact on quality of life. For that reason, many patients at our institution have been treated with mFOLFOX6 with better tolerability instead of FOLFIRINOX in the palliative setting. Methods: We performed a retrospective chart review to analyze overall survival in patients withof unresectable pancreatic cancer (locally advanced and metastatic). Institutional tumor registry database was used to identify patients with unresectable pancreatic adenocarcinoma from January 2009 to March 2012. Medical records were reviewed to identify patients who were treated with at least 1 cycle of modified FOLFOX-6 as a line of treatment during their disease course. Overall survival was calculated for this cohort of patients. Results: 26 patients (15 male, 11 female) with unresectable pancreatic adenocarcinoma were identified. Mean age was 65.3 years. 19 patients had metastatic disease whereas 7 patients had locally advanced disease at diagnoses. Modified FOLFOX6 as a 1st line, 2nd line and 3rd line therapy was given in 17, 6 and 3 patients respectively. The median overall survival was 9 month while the mean survival was 10.6 months. 7 patients were treated with FOLFIRI as 2nd or 3rd line treatment. Nine patients are still alive. Conclusions: Modified FOLFOX-6 is an acceptable treatment for metastatic and locally advanced pancreatic adenocarcinoma. Even though our sample size is small, overall survival is comparable to that of FOLFIRINOX. A multi-institutional, randomized trial evaluating sequencing of mFOLFOX6 and FOLFIRI and comparing it with FOLFIRINOX would be useful.

Longer Course of Induction Chemotherapy Followed by Chemoradiation Favors Better Survival Outcomes for Patients With Locally Advanced Pancreatic Cancer

“…There is a need to further investigate the optimal chemotherapy regimens for LAPC, such as exploring the use of newer regimens typically used for metastatic disease (for example, FOLFIRINOX, modified FOLFOX-6, or gemcitabine plus nab-paclitaxel). 16–19 A recent phase II trial found that gemcitabine may have more hematologic and non-hematologic toxicity compared to capecitabine, which may be more effective and safer as a chemotherapy arm for LAPC. 20 More recently, another phase II study showed that a triple combination for induction chemotherapy (gemcibatine, oxaliplatin, and 5-FU/leucovorin) followed by gemcitabine-based chemoradiation produced encouraging survival results for LAPC.…”