First line modified Folfirinox versus gemcitabine for advanced pancreatic cancer: A single institution retrospective experience

Eraslan, Emrah; Yıldız, Fatih; Tufan, Gulnihal; Aslan, Ferit; Demirci, Umut; Öksüzoğlu, Ömür Berna

doi:10.1016/j.jons.2019.03.002

Cited by 3 publications

(3 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Concerning hematotoxicity, 15.4% of our patients experienced grade 2 neutropenia, but no patient developed febrile neutropenia. The systematic use of pegfilgrastim support probably explains the few adverse events, contrasting with previous reports of grade 3-4 neutropenia with FOLFIRINOX in metastatic pancreatic cancer (45.7%), or in the TRIBE2 study with FOLFOXIRI-bevacizumab for mCRC (50%) [34]. There was no case of grade 3 thrombopenia in our study.…”

Section: Discussioncontrasting

confidence: 99%

Phase I Dose-Escalation Trial of an Innovative Chemotherapy Regimen Combining a Fractionated Dose of Irinotecan Plus Bevacizumab, Oxaliplatin, 5-Fluorouracil, and Folinic Acid (bFOLFIRINOX-3) in Chemorefractory Metastatic Colorectal Cancer

Bellio

Bertaut

Hervieu

et al. 2021

Cancers

View full text Add to dashboard Cite

The care of metastatic colorectal cancers is based on combination chemotherapies including 5-fluorouracil, oxaliplatin, irinotecan, and monoclonal antibodies targeting the epidermal growth factor receptor or vascular endothelial growth factor. The regimen is determined based on the patient’s molecular biology and general condition. Irinotecan bifractionation showed efficacy in chemorefractory patients in a previous study, FOLFIRI-3, but a desynchronized triplet has never been tested. The aim of bFOLFIRINOX-3 is to determine the safety, tolerance, and efficacy of a new regimen (FOLFIRINOX-3 bevacizumab) in chemorefractory patients. The aim of this study was to evaluate the safety and efficacy of FOLFIRINOX-3 bevacizumab in chemorefractory metastatic colorectal cancer (mCRC). A standard phase I, “3 + 3” design study was performed. The standard protocol comprised simplified FOLFOX 4 (folinic acid 400 mg/m2), 5-fluorouracil (a 400 mg/m2 bolus followed by 2400 mg/m2 for 46 h), oxaliplatin (85 mg/m2) and irinotecan (administered before and after 5-fluorouracil infusion), plus bevacizumab (5 mg/kg). In a “3 + 3” design, three different doses of irinotecan were tested: 60, 70 and 90 mg/m2. The primary endpoint was the maximum tolerable dose (MTD) of irinotecan. The secondary endpoints included the objective response (at 8 and 16 weeks) according to the RECIST 1.1 criteria and progression free survival. Thirteen patients were enrolled, and twelve patients were finally evaluated for dose-limiting toxicity (DLT). The dose level defined was 70 mg/m2 irinotecan. A total of three DLTs were observed (grade 3 diarrhea): two DLTs at the 90 mg/m2 dose level and one at the 70 mg/m2 dose level. The most frequently described adverse events were asthenia (93%), diarrhea (77%), nausea (62%) and peripheral sensory neuropathy (46%). The most frequent biological event was thrombopenia (54%). Regarding efficacy, among the 11 evaluable patients, no progression was observed at 8 weeks, and the partial response rate was 18.2%. At 16 weeks, a partial response rate of 27.3% was observed, and five patients had a stable disease. The new regimen of bFOLFIRINOX-3 with irinotecan at 70 mg/m2 was well tolerated. In chemorefractory patients, this protocol shows a high response rate.

show abstract

Section: Discussioncontrasting

confidence: 99%

Phase I Dose-Escalation Trial of an Innovative Chemotherapy Regimen Combining a Fractionated Dose of Irinotecan Plus Bevacizumab, Oxaliplatin, 5-Fluorouracil, and Folinic Acid (bFOLFIRINOX-3) in Chemorefractory Metastatic Colorectal Cancer

Bellio

Bertaut

Hervieu

et al. 2021

Cancers

View full text Add to dashboard Cite

show abstract

“…Finally, 37 studies were included for evidence-mapping of the trend of ‘planned’ and ‘actual’ dose of FOLFIRINOX, and 27 studies were included in the meta-analysis for comparison of clinical outcome according to planned dose of FOLFIRINOX. 3 , 6 – 8 , 16 – 48 …”

Section: Resultsmentioning

confidence: 99%

“…Of the 37 studies, 11 and 26 were prospective studies 3 , 16 – 25 and retrospective studies, 6 – 8 , 26 – 48 respectively ( Table 1 ). The country included the most was Japan ( N = 10) followed by Korea ( N = 6), USA ( N = 5), and China ( N = 5).…”

Section: Resultsmentioning

confidence: 99%

Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis

et al. 2023

View full text Add to dashboard Cite

Background: FOLFIRINOX, used in metastatic pancreatic cancer (MPC), is highly efficacious but also toxic. Various dose modifications for FOLFIRINOX have been introduced to reduce toxicity. However, these studies lack a unified pattern for ‘planned’ dose modification, and the ‘actually administered’ dose varied more. Objective: To map a 10-year trend for ‘planned’ and ‘actual’ doses of FOLFIRINOX and investigate the clinical outcomes according to dose modification. Data sources and methods: A comprehensive systematic literature search was conducted from January 2011 to September 2021. All studies for FOLFIRINOX as first-line treatment in MPC were considered. Selected studies were firstly classified according to prospective versus retrospective research, secondly standard versus modified FOLFIRINOX, and thirdly ‘planned’ versus ‘actual’ dose. For evidence-mapping for the trend of dose modification, we developed a web-based interactive bubble-plot program ( www.RDI-map.com ). Objective response rate (ORR) and hematologic toxicity were set as endpoints for the comparison of clinical outcomes according to dose modification. Results: A total of 37 studies were identified for evidence-mapping (11 prospective and 26 retrospective studies). There were 12 different types of ‘planned’ dose modification in FOLFIRINOX ranging 75–100% oxaliplatin, 75–100% irinotecan, 0–100% 5-fluorouracil (5-FU) bolus, and 75–133% 5-FU continuous injection. The ‘actual’ dose further decreased to 54–96%, 61–88%, 0–92%, and 63–98%, respectively. For the standard versus modified FOLFIRINOX, the ORR was 28.2% (95% CI: 22.5–33.9%) and 33.8% (95% CI: 30.3–37.3%), respectively ( p = 0.100), and the incidence of febrile neutropenia was 11.6% (95% CI: 0–16.0%) and 5.5% (95% CI: 0–8.9%), respectively ( p = 0.030). Conclusions: RDI-map.com enables multifactorial evidence-mapping for practical FOLFIRINOX dose reduction. The pattern of dose modification was not consistent across studies, and there was a significant gap between the ‘planned’ and ‘actual’ doses. Modified FOLFIRINOX showed similar efficacy to the standard regimen with reduced incidence of febrile neutropenia.

show abstract

Survival of colorectal cancer patients in Brunei Darussalam: comparison between 2002–09 and 2010–17

et al. 2021

View full text Add to dashboard Cite

Background Colorectal cancer (CRC) is a major cause of cancer-related mortality worldwide. It is the second leading cause of cancer death in men and women in Brunei Darussalam in 2017, posing a major burden on society. Methods This retrospective cohort study (n = 1035 patients diagnosed with CRC in Brunei Darussalam from 1st January 2002 until 31st December 2017) aims to compare the overall survival rates of CRC patients (2002–2017), to compare survival rates between two study periods (2002–2009 and 2010–2017) and to identify prognostic factors of CRC. Kaplan-Meier estimator and log-rank tests were performed to analyse the overall survival rates of CRC patients. Multiple Cox regression was performed to determine the prognostic factors of CRC with adjusted hazard ratios (Adj. HRs) reported. Results The 1-, 3- and 5-year survival rates of CRC patients are 78.6, 62.5, and 56.0% respectively from 2002 to 2017. The 1-, 3-, and 5-year survival rates of CRC patients for 2002–2009 are 82.2, 69.6, and 64.7%; 77.0, 59.1, and 51.3% for 2010–2017 respectively. A significant difference in CRC patients’ survival rate was observed between the two study periods, age groups, ethnic groups, cancer stages, and sites of cancer (p < 0.05). The Adjusted Hazard Ratios (Adj. HRs) were significantly higher in the 2010–17 period (Adj. HR = 1.78, p < 0.001), older age group ( ≥ 60 years) (Adj. HR = 1.93, p = 0.005), distant cancer (Adj. HR = 4.69, p < 0.010), tumor at transverse colon and splenic flexure of colon (Adj. HR = 2.44, p = 0.009), and lower in the Chinese(Adj. HR = 0.63, p = 0.003). Conclusion This study highlights the lower survival rates of CRC patients in 2010–2017, Malays, older patients, distant cancer, and tumors located at the latter half of the proximal colon (transverse colon), and predominantly LCRC (splenic flexure, descending colon, sigmoid colon, overlapping lesion colon and colon (NOS), as well as the rectosigmoid junction and rectum (NOS)). Age, ethnicity, cancer stage, and tumor location are significant prognostic factors for CRC. These findings underscore the importance of public health policies and programmes to enhance awareness on CRC from screening to developing strategies for early detection and management, to reduce CRC-associated mortality.

show abstract

First line modified Folfirinox versus gemcitabine for advanced pancreatic cancer: A single institution retrospective experience

Cited by 3 publications

References 14 publications

Phase I Dose-Escalation Trial of an Innovative Chemotherapy Regimen Combining a Fractionated Dose of Irinotecan Plus Bevacizumab, Oxaliplatin, 5-Fluorouracil, and Folinic Acid (bFOLFIRINOX-3) in Chemorefractory Metastatic Colorectal Cancer

Phase I Dose-Escalation Trial of an Innovative Chemotherapy Regimen Combining a Fractionated Dose of Irinotecan Plus Bevacizumab, Oxaliplatin, 5-Fluorouracil, and Folinic Acid (bFOLFIRINOX-3) in Chemorefractory Metastatic Colorectal Cancer

Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis

Survival of colorectal cancer patients in Brunei Darussalam: comparison between 2002–09 and 2010–17

Contact Info

Product

Resources

About