Chemo combination promising in pancreatic cancer

Last Updated: 2016-05-20

By David Douglas

NEW YORK (Reuters Health) - Pooled data indicate that FOLFIRINOX (leucovorin and fluorouracil plus irinotecan and oxaliplatin) may do better than the standard approach to treatment of advanced pancreatic cancer, according to European and U.S. researchers.

As Dr. Bas Groot Koerkamp told Reuters Health by email, "Our study presents the best available evidence to treat patients with locally advanced pancreatic cancer and a good performance status with FOLFIRINOX rather than gemcitabine."

Dr. Groot Koerkamp of Erasmus University Medical Center, Rotterdam and colleagues conducted a systematic review and patient-level meta-analysis. The team analyzed 13 studies, all of which included treatment-naive patients of any age who received first-line therapy with FOLFIRINOX.

Overall, the studies comprised 689 patients, of whom 355 (52%) had locally advanced pancreatic cancer. Eleven studies with 315 such patients reported survival outcomes and were used in patient-level meta-analysis.

The median overall survival after the start of therapy ranged from 10.0 to 32.7 months, the researchers report in an article online May 6 in The Lancet Oncology. Pooled patient-level median overall survival was 24.2 months.

Median progression-free survival ranged from 3.0 to 20.4 months, with a pooled median of 15.0 months.

Although no deaths were attributed to FOLFIRINOX, in 490 patients there were a total of 296 grade 3 or 4 adverse events.

The proportion of patients who underwent radiotherapy or chemoradiotherapy ranged from 31% to 100% across studies. The pooled proportion of patients who received any radiotherapy treatment was 63.5%. Across studies, the proportion of patients who underwent surgical resection ranged from none to 43%.

The researchers conclude that given the 24.2 month median survival with FOLFIRINOX compared to the 5 to 13 months reported with gemcitabine, the combination appears promising.

"A randomized trial should determine definitively whether FOLFIRINOX results in superior survival and quality of life," Dr. Groot Koerkamp added.

Commenting on the findings by email, Dr. Vincent J. Picozzi of the Virginia Mason Medical Center in Seattle told Reuters Health the study shows promise for patients on two fronts.

"First, it displays the potential of more contemporary combination chemotherapy such as FOLFIRINOX to improve patient survival," said Dr. Picozzi, who was not involved in the work. "Second, it illustrates an evolving belief that current guidelines for pancreatic cancer resection may be too inexact, and that some patients deemed inoperable may indeed be operative candidates and thus have a potential for curative treatment."

However, Dr. Picozzi, who is director of the Pancreatic Center of Excellence, concluded that "it should be noted that many pancreatic cancer patients are unable to tolerate FOLFIRINOX, and that analyses of the type performed in this manuscript have many limitations (as the authors correctly point out)." As such, the observations advanced "should be seen as hypothesis-generating, rather than as a definitive standard of care."

The study had no funding.

SOURCE: http://bit.ly/1U3gyTg

Lancet Oncol 2016.