Modified FOLFIRINOX for unresectable locally advanced/metastatic pancreatic cancer. A real-world comparison of an attenuated with a full dose in a single center experience
Modified FOLFIRINOX for unresectable locally advanced/metastatic pancreatic cancer. A real-world comparison of an attenuated with a full dose in a single center experience
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DOI：
10.2147/ott.s200754
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发表时间：
2019-01-01
影响因子：
4
通讯作者：
Vecchia, Stefano
中科院分区：
文献类型：
--
作者：
Cavanna, Luigi;Stroppa, Elisa Maria;Vecchia, Stefano
目的：转移性胰腺癌的预后很差。尽管与仅使用吉西他滨 (GEM) 相比，伊立替康、奥沙利铂和亚叶酸调节的氟尿嘧啶 (FOLFIRINOX) 显着提高了晚期胰腺癌的生存率，但毒性降低了人们对其使用的热情。 方法：本研究回顾性分析了在意大利综合医院接受治疗的未经选择的局部晚期不可切除或转移性胰腺癌患者中使用全剂量和减毒剂量 FOLFIRINOX 的真实世界临床实践医院。评估疗效、耐受性和毒性，并通过 Kaplan-Meier 法估计总生存期 (OS) 和无进展生存期 (PFS)。 结果：意大利北部皮亚琴察总医院肿瘤科连续 50 名晚期 (13) 或转移性 (37) 胰腺腺癌患者接受 FOLFIRINOX 治疗。该系列中第一个连续入组的 18 名患者 (36%) 开始接受全剂量的治疗，而随后的 32 名连续患者 (64%) 接受剂量减量（-20% 推注氟尿嘧啶和 -25% 伊立替康）。在整个组中，缓解率、中位 OS 和中位 PFS 分别为 30%、10.1 个月和 5.6 个月，接受减毒剂量化疗的 32 名患者与接受全剂量化疗的 18 名患者相比，客观缓解没有差异。然而，与接受减毒剂量 FOLFIRINOX 的 32 名患者相比，接受全剂量 FOLFIRINOX 的 18 名患者的中性粒细胞减少症、贫血、疲劳和呕吐在统计学上有所增加（p
Purpose: Metastatic pancreatic adenocarcinoma has a very poor prognosis. Although irinotecan, oxaliplatin and leucovorin-modulated fluorouracil (FOLFIRINOX) significantly increases survival in advanced pancreatic cancer, compared to employing only gemcitabine (GEM), toxicities have tempered enthusiasm for its use.Methods: This study retrospectively analyses the real-world clinical practice with full and attenuated doses of FOLFIRINOX in unselected patients with locally advanced unresectable or metastatic pancreatic cancer, treated at an Italian general hospital. Efficacy, tolerability, and toxicity were evaluated, and overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier method.Results: Fifty consecutive patients with advanced (13) or metastatic (37) pancreatic adenocarcinomas were treated with FOLFIRINOX at the Medical Oncology Unit, Piacenza General Hospital, North Italy. The first enrolled consecutive 18 patients (36%) of this series started the treatment with a full dose of the regimen, while the subsequent 32 (64%) consecutive patients received dose attenuation (-20% bolus fluorouracil and -25% irinotecan). In the entire group, the response rate, median OS, and median PFS were 30%, 10.1 months, and 5.6 months, respectively, with no differences in objective response in the 32 patients that received an attenuated dose compared with the 18 patients receiving a full dose of chemotherapy. However, neutropenia, anemia, fatigue, and vomiting were statistically increased in the 18 patients receiving a full dose compared with the 32 patients receiving an attenuated dose of FOLFIRINOX (p