FOLFIRINOX in the real world setting: The multicentric experience of six Canadian institutions.

Amireault, Carl; Ayoub, Jean-Pierre M.; Beaudet, Julie; Gaudet, Guylaine; Létourneau, Richard; Loungnarath, Rasmy; Raymond, Nicolas; Tehfé, Mustapha; Aubin, Francine

doi:10.1200/jco.2014.32.15_suppl.e15232

Cited by 4 publications

(7 citation statements)

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“…Significant differences in outcomes between patients with LAPC and metastatic disease (median OS: 13.6 vs 18.7 months; HR = 0.55; p = 0.041) were detected in our cohort. Accordingly, a Canadian retrospective study (median OS: 14 months in metastatic disease and 18.4 months in LAPC) (22) and the Royal Marsdem experience showed similar results (median OS: 10.4 months in metastatic disease and 18.4 months in LAPC). (15) These similarities in outcomes between our study and others are of particular relevance, specially considering ours was conducted in an emerging country.…”

Section: Ca199mentioning

confidence: 67%

“…(24) In the present study, hospitalization during treatment with FOLFIRINOX occurred in 31.1% of patients; the main cause was sepsis/infection, and this is in consonance with other reports. (8)(9)(10) No catheter complications were detected.…”

Section: Ca199mentioning

confidence: 94%

“…Fifty patients had elevated CA19.9, and median level was 1277 U/mL; CA 19.9 levels were missing in two patients. Twenty-seven patients had >50% decreases in CA 19.9 levels after FOLFIRINOX treatment and there was a trend to increased OS (HR=0.77; 95% CI = 0.40-1.45) in this group (median OS: 19.10 months) when compared with the group who had less than 50% decrease or increase in CA19.9 (median OS: Ghorani et al ∆ (13) 2015 18 8.9 46.7 N/R Zahir et al (14) 2015 101 10.5 N/R N/R Takeda et al # (12) 2015 10 N/R 10 N/R Moorcraft et al (15) 2014 49 12.9 41 N/R (29% of grade 3/4 neutropenia) Kraemer et al (16) 2014 16 8.45 50 N/R Hohla et al (17) 2014 49 13 55.1 N/R Amireault et al (9) 2014 46 12.6 N/R N/R (3 treatment-related deaths)…”

Section: Ca199mentioning

confidence: 99%

“…(7) During the past few years, many distinct centers have reported their experience with the use of FOLFIRI-NOX or modified FOLFIRINOX regimens in real-life experience for advanced PDA, with heterogeneous results regarding efficacy and toxicity. (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) Indeed, a meta-analysis of 13 studies (11 of them retrospective studies and none of them conducted in developing countries) confirmed the survival improvement after FOLFIRINOX treatment when compared to gemcitabine in patients with locally advanced pancreatic cancer (LAPC). In this way, reports of FOL-FIRINOX administration for advanced PDA in low to mid-income countries and South America are still lacking in the literature and may pose a relevant piece of evidences in everyday clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

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FOLFIRINOX for advanced pancreatic adenocarcinoma in Brazil: a single-institution experience

Mota¹,

Silva²,

Franco³

et al. 2018

BJOncology

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Objective: Data is lacking about FOLFIRINOX use for advanced pancreatic ductal adenocarcinoma in emerging countries. The objective of this study was to report outcomes of effi cacy and safety in the setting of a South American institution. Methods: Patients treated with FOLFIRINOX for metastatic or locally advanced pancreatic cancer at Instituto do Câncer do Estado de São Paulo (Brazil), between November 2012 and January 2016 were retrospectively reviewed. Baseline characteristics, safety, response and overall survival were analyzed. Results: Sixty-one patients were enrolled (metastatic disease: 31). Median age was 61 years (range 37-74), and 88.5% had ECOG 0 or 1; 90.2% had T3 or T4 tumors and 36.1% had node-positive disease. FOLFIRINOX was given as the fi rst-line treatment in 88.5% of patients, and was discontinued due to disease progression (55.7%), limiting toxicity (31.1%) or maximum benefi t (13.1%). Median number of cycles was 10 (range 1-32). Dose reductions occurred in 81.9%. Grade 3 or 4 toxicity were found in 60.6% and were mainly hematological (36%), neuropathy (19.6%), fatigue (8.2%) and diarrhea (14.7%). Two patients had febrile neutropenia. Hospitalization during treatment occurred in 31.1% of cases, with three potential treatment-related deaths. Median overall survival was 16.26 in the full cohort; 13.6 in patients with metastatic disease, and 18.7 months in locally advanced disease. The response rate was 39.3% (32.2% in metastatic disease and 43.3% in locally advanced disease). Conclusion: Despite the high prevalence of grade 3 or 4 toxicities, FOLFIRINOX showed effi cacy for the treatment of patients with advanced pancreatic adenocarcinoma, and is an excellent treatment option in emerging countries.

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Section: Ca199mentioning

confidence: 67%

Section: Ca199mentioning

confidence: 94%

Section: Ca199mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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FOLFIRINOX for advanced pancreatic adenocarcinoma in Brazil: a single-institution experience

Mota¹,

Silva²,

Franco³

et al. 2018

BJOncology

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“…Oncologists in the United States and elsewhere were anxious to use FFX, but initially concerned about toxicity, particularly in patients with lesions in the head of the pancreas and with biliary stents. A Canadian report suggested that there could be considerable toxicity when the regimen is used outside of a clinical study and in community centers 17 . In their series of 46 patients, there were 3 (7%) treatment-related deaths, 54% of patients were hospitalized with sepsis, 33% had neutropenia grade ≥3, 15% had diarrhea grade ≥3, and 4 (9%) patients had febrile neutropenia.…”

Section: Do Modifications To the Ffx Regimen Matter?mentioning

confidence: 99%

Pancreatic cancer and FOLFIRINOX: a new era and new questions

et al. 2015

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FOLFIRINOX (FFX) was introduced to clinical practice in 2010 following publication of the PRODIGE 4/ACCORD 11 study, which compared this novel regimen to gemcitabine in metastatic pancreatic cancer. Median overall survival, progression-free survival, and objective responses were all superior with FFX and there was improved time to definitive deterioration in quality of life. Despite initial concerns over toxicity, there has been rapid uptake of this regimen, both revolutionizing management and opening the door to innovative research. As experience with FFX has accrued, many questions have arisen including the management of toxicities, the impact of frequent modifications, the optimal number of cycles, integration with other regimens and modalities, interpretation of radiologic and serologic response, utility of molecular signatures, and potential benefit in unique clinical settings such as pre- and postsurgery. This review will closely examine these issues, not only to summarize current knowledge but also to fuel scientific debate.

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Impact of Granulocyte Colony-Stimulating Factor (G-CSF) on the Outcomes of Patients With Metastatic Pancreatic Adenocarcinoma (MPA) During First-Line Treatment With FOLFIRINOX: A Single-Center Retrospective Analysis

2023

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Introduction The role of primary prophylaxis (PP) with granulocyte colony-stimulating factor (G-CSF) for patients with metastatic pancreatic adenocarcinoma (MPA) treated with FOLFIRINOX is unknown. We aimed to compare the frequencies of grades 3 or 4 neutropenia (G3/4N) and febrile neutropenia (FN) and survival outcomes according to the use of PP. Methods This is a retrospective study. We included patients with pathologically confirmed MPA treated with FOLFIRINOX in first-line. Patients who received primary prophylaxis (PP group) were compared to patients who received secondary or no G-CSF (no-PP group). Overall survival (OS) and progression-free survival (PFS) were evaluated using the standard Cox proportional hazard model. To account for potential biases, we performed sensitivity analyses excluding patients who received secondary prophilaxis and treating G-CSF as a time-dependent covariate in extended Cox proportional hazard models. Results The study population consisted of 123 patients. PP was used by 75 patients (61.0%). G3/4 N occurred more frequently among patients without PP (10.7 vs 41.7%; P < .001). There was no difference in the frequency of FN between groups (5.3 vs 8.3%; P = .710). In multivariate analysis, PP was associated with a trend toward improved OS (HR = .66; 95% confidence interval [95% CI] .41 - 1.07; P = .094). In the multivariate model excluding patients with secondary prophylaxis (HR = .54; 95% CI 0.32 - .91; P = .022) and in the time-dependent model (HR = .47; 95% CI 0.28 - .80; P = .005), PP was associated with statistically superior OS. Conclusions Despite the reduction in the frequency of G3/4N, the risk of FN among patients treated with FOLFIRINOX without G-CSF is too low to justify its use in a routine basis. However, given the potential of G-CSF to improve survival in this setting, further studies are warranted to assess its role during treatment with FOLFIRINOX for patients with MPA.

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FOLFIRINOX in the real world setting: The multicentric experience of six Canadian institutions.

Cited by 4 publications

References 0 publications

FOLFIRINOX for advanced pancreatic adenocarcinoma in Brazil: a single-institution experience

FOLFIRINOX for advanced pancreatic adenocarcinoma in Brazil: a single-institution experience

Pancreatic cancer and FOLFIRINOX: a new era and new questions

Impact of Granulocyte Colony-Stimulating Factor (G-CSF) on the Outcomes of Patients With Metastatic Pancreatic Adenocarcinoma (MPA) During First-Line Treatment With FOLFIRINOX: A Single-Center Retrospective Analysis

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