Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort.

IF 2.8 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2025-03-27 DOI:10.1016/j.pan.2025.03.011

A A van Zweeden, L G M van der Geest, E N Pijnappel, J de Vos-Geelen, J E van Hooft, M W J Stommel, G F de Wit, H M W Verheul, H W M van Laarhoven, H J van der Vliet, J W Wilmink

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引用次数: 0

Abstract

Background: FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) can improve the prognosis of advanced pancreatic ductal adenocarcinoma (PDAC). Upon progression after a therapy-free interval it is not uncommon to reintroduce FOLFIRINOX, depending on the response and progression free interval after first-line FOLFIRINOX. The aim of this study is to provide an overview of the use and effectiveness of FOLFIRINOX reintroduction in daily practice.

Patients and methods: Patients with locally advanced and metastatic PDAC, diagnosed between 2015 and 2018, who started systemic treatment with palliative intent were selected from the Netherlands Cancer Registry (NCR). Overall and progression free survival (OS, PFS) were evaluated using Kaplan-Meier curves with log-rank tests.

Results: In this cohort of 2092 patients, most were treated with first-line FOLFIRINOX (1381; 66 %). The median OS was 9.0 months. A total of 388 patients (28 %) received subsequent systemic therapy after first-line FOLFIRNOX; 119 (30.7 %) patients were re-treated with FOLFIRINOX after a minimum of 3 months treatment interruption while 269 patients received other therapies, mostly gemcitabine/nab-paclitaxel or gemcitabine monotherapy. The median therapy-free interval between first-line FOLFIRINOX and FOLFIRINOX reintroduction was 7.0 months (p25-p75: 4,6-10,6). Patients underwent a median of 5 cycles (range: 1-32) during initial treatment and 5 cycles (range: 1-28) during FOLFIRINOX reintroduction. Median OS after FOLFIRINOX reintroduction was 23.4 months, and median progression-free survival was 6.8 months.

Conclusion: Reintroduction of FOLFIRINOX after at least 3 months therapy-free interval is used in daily practice and seems a reasonable treatment option based on a favorable OS and PFS in a small subset of patients.

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背景：FOLFIRINOX（5-氟尿嘧啶、亮菌素、奥沙利铂和伊立替康）可改善晚期胰腺导管腺癌（PDAC）的预后。在无治疗间隔期后出现进展时，根据一线 FOLFIRINOX 治疗后的反应和无进展间隔期，重新使用 FOLFIRINOX 的情况并不少见。本研究旨在概述在日常实践中重新引入 FOLFIRINOX 的使用情况和效果：从荷兰癌症登记处（NCR）选取了2015年至2018年间确诊的局部晚期和转移性PDAC患者，这些患者以姑息治疗为目的开始接受系统治疗。采用Kaplan-Meier曲线和对数秩检验评估总生存期和无进展生存期（OS、PFS）：在这组 2092 例患者中，大多数接受了一线 FOLFIRINOX 治疗（1381 例，66%）。中位 OS 为 9.0 个月。共有388名患者（28%）在接受了一线FOLFIRNOX治疗后接受了后续系统治疗；119名患者（30.7%）在中断治疗至少3个月后再次接受了FOLFIRINOX治疗，269名患者接受了其他疗法，主要是吉西他滨/纳布紫杉醇或吉西他滨单药治疗。从一线FOLFIRINOX治疗到再次接受FOLFIRINOX治疗的中位无治疗间隔时间为7.0个月（P25-P75：4.6-10.6）。患者在初始治疗期间接受的治疗周期中位数为 5 个周期（范围：1-32），在重新引入 FOLFIRINOX 期间接受的治疗周期中位数为 5 个周期（范围：1-28）。重新引入FOLFIRINOX后的中位OS为23.4个月，中位无进展生存期为6.8个月：结论：在至少 3 个月的无治疗间隔期后重新使用 FOLFIRINOX 是日常实践中常用的治疗方法，而且在一小部分患者中具有良好的 OS 和 PFS，因此似乎是一种合理的治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.