Folfirinox in elderly patients with pancreatic or colorectal cancer-tolerance and efficacy.
Folfirinox in elderly patients with pancreatic or colorectal cancer-tolerance and efficacy.
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DOI：
10.3748/wjg.v22.i42.9378
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发表时间：
2016-11-14
影响因子：
4.3
通讯作者：
Bengrine-Lefevre L
中科院分区：
文献类型：
--
作者：
Guion-Dusserre JF;Bertaut A;Ghiringhelli F;Vincent J;Quipourt V;Marilier S;Tharin Z;Bengrine-Lefevre L
目的：研究老年结直肠癌或胰腺癌患者对FOLFIRINOX的耐受性及疗效。这项回顾性研究纳入了2009年1月至2015年1月期间在乔治-弗朗索瓦勒克莱尔中心接受FOLFIRINOX治疗的组织学证实的结直肠癌或胰腺癌的70岁以上老年患者。化疗方案包括奥沙利铂（85 mg/m2，超过120分钟），然后是亚叶酸素（400 mg/m2，超过120分钟），另外，伊立替康（180 mg/m2，超过90分钟）30分钟后，然后是5氟尿嘧啶（400 mg/m2，静脉滴注），然后是5FU （2400 mg/m2，静脉滴注，超过46小时），每2周重复一次。开始时记录老年参数。根据不良事件通用术语标准4.03评估毒性。CT扫描评价肿瘤反应。治疗持续到疾病进展，出现不可接受的毒性或患者拒绝。52例患者年龄从70岁到87岁不等，其中34例为结直肠癌，18例为胰腺癌。大部分患者一般情况良好，82.7%的患者表现为0-1,61.5%的患者Charlson合并症指数< 10。最常见的严重毒性是中性粒细胞减少（17例，n = 32.7%）和腹泻（35例，n = 67.3%）；10例中性粒细胞减少和5例腹泻的毒性为4级。39名患者（75%）最初接受了适应剂量的化疗。26%的患者在治疗过程中调整了剂量。RECIST标准评估的肿瘤反应显示25例（48.1%）患者病情控制，13例病情稳定，12例部分缓解。结肠直肠癌的治疗时间更长，中位时间为2.44个月（95%CI: 1.61-3.25）。结直肠癌的总生存期为43.88个月，胰腺癌为12.51个月。在单因素或多因素分析中，没有老年参数与总生存率相关。在这两种分析中，只有肿瘤类型（胰腺/结直肠）是相关的。对于70岁以上的患者，FOLFIRINOX方案似乎诱导可控的毒性，但与年轻人相比，其中位生存率相似，甚至更高。
To study the tolerance and the efficiency of FOLFIRINOX in elderly patients diagnosed with colorectal or pancreatic cancer. This retrospective study included elderly patients aged over 70 years of age treated at Georges-Francois Leclerc Center by FOLFIRINOX for histological proved colorectal or pancreatic cancer between January 2009 and January 2015. Chemotheapy regimen consisted of oxaliplatin (85 mg/m2 in over 120 min) followed by leucovorin (400 mg/m2 in over 120 min), with the addition, after 30 min of irinotecan (180 mg/m2 in over 90 min) then 5 fluorouracil (5FU) (400 mg/m2 administred intravenous bolus), followed by 5FU (2400 mg/m2 intraveinous infusion over 46 h) repeated every 2 wk. Geriatric parameters were recorded at the beginning. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events 4.03. Tumor response was evaluated by CT scan. Treatment continued until disease progression, unacceptable toxicities or patient refusal. Fifty-two patients aged from 70 to 87 years were treated by FOLFIRINOX, 34 had colorectal cancer and 18 had pancreatic cancer. Most of them were in good general condition, 82.7% had a 0-1 performance status and 61.5% had a Charlson Comorbidity Index < 10. The most frequent severe toxicities were neutropenia (17 patients, n = 32.7%) and diarrhea (35 patients n = 67.3%); 10 of the case of neutropenia and 5 of diarrhea registered a grade 4 toxicity. Thirty-nine patients (75%) initially received an adapted dose of chemotherapy. The dosage was adjusted for 26% of patients during the course of treatment. Tumor response evaluated by RECIST criteria showed a controlled disease for 25 patients (48.1%), a stable disease for 13 and a partial response for 12 patients. Time under treatment was higher for colorectal cancer with a median time of 2.44 mo (95%CI: 1.61-3.25). Overall survival was 43.88 mo for colorectal cancer and 12.51 mo for pancreatic cancer. In univariate or multivariate analysis, none of geriatric parameters were linked to overall survival. Only the type of tumor (pancreatic/colorectal) was linked in both analysis. For people over 70 years old, FOLFIRINOX regimen seems to induce manageable toxicities but similar, even higher, median survival rates compared to younger people.
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