To remember

 

The clinicians of two reference centers for the management of cancer compared the efficacy of the FOLFOXIRI protocol to the FOLFIRINOX protocol in patients suffering from advanced ductal adenocarcinoma of the pancreas (ACPa). No benefit from one protocol over the other could be demonstrated. The FOLFIRINOX protocol thus remains the benchmark protocol in this context. However, this study highlights the value of prophylactic administration of hematopoietic growth factors routinely after each cycle of chemotherapy.

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Why are these results interesting?

 

Currently, the FOLFIRINOX protocol is the first-line reference treatment in advanced pancreatic adenocarcinoma. The prognosis associated with advanced ductal adenocarcinoma of the pancreas is poor, especially due to a late diagnosis. The overall 5-year survival being estimated between 8 and 9%. Overall survival can be improved to 54.4 months on average, by complete localized surgical resection followed by 6 months of chemotherapy. Any protocol that can improve these parameters is therefore interesting.

Methodology

 

Patients suffering from advanced adenocarcinoma of the pancreatic duct and treated consecutively as first-line treatment with a FOLFOXIRI (n = 165, at the Besançon University Hospital) or FOLFIRINOX (n = 124, at the Lille University Hospital) protocol included in this exploratory study.

The FOLFIRINOX protocol consists of the combination of oxaliplatin (85 mg / m2), leucovorin (400 mg / m2), irinotecan (180 mg / m2) and 5-FU (400 mg / m2 as bolus IV on D1 and a continuous infusion 2,400 mg / m2 over 46h from D1).

The FOLFOXIRI protocol uses the same molecules, but with a reduced dose for irinotecan and the absence of a 5-FU bolus (according to a protocol used in metastatic colorectal cancer). Thus, the FOLFOXIRI protocol consists of the combination of irinotecan (165 mg / m2), oxaliplatin (85 mg / m2), leucovorein (200 mg / m2) and 5-FU (3,200 mg / m2 in continuous infusion during 48h). The efficacy and tolerance of these two treatments could be compared face-to-face from 96 paired patients.

Principle results

 

The two treatment groups had similar characteristics except for the location of the tumor (located at the level of the pancreatic head for 43.1% of individuals on FOLFIRINOX and for 56.7% on FOLFORIXI), the severity of the disease (grade histological at the time of initiation of chemotherapy, greater number of metastatic sites in the FOLFIRINOX group than in the FOLFOXIRI group), and the pain level of the subjects – judged by morphine consumption.

The median follow-up rate was 26.7 months in the FOLFIRINOX group and 44.2 months in the FOLFOXIRI group.

After pairing, the overall survival and progression-free survival rates were similar between the two arms (hazard ratio: 1.22; p = 0.120). All patients received hematopoietic growth factors after each cycle of chemotherapy and a low rate of hematological toxicity was found in both arms.

The rates of grade 3 or 4 toxicity events (including digestive and hematological events) were similar between the two groups (p = 0.362).

Retrospective study. Patients treated in two different centers according to the protocols used.

Vienot A, Chevalier H, Bolognini C, Gherga E, Klajer E, Meurisse A, Jary M, Kim S, d’Engremont C, Nguyen T, Calcagno F, Almotlak H, Fein F, Nasri M, Abdeljaoued S, Turpin A, Borg C, Vernerey D. FOLFOXIRI vs FOLFIRINOX as first-line chemotherapy in patients with advanced pancreatic cancer: A population-based cohort study. World J Gastrointest Oncol. 2020; 12 (3): 332-346. doi: 10.4251 / wjgo.v12.i3.332. PMID: 32206183 PMID: 19097774 PMID: 23817973 PMID: 29487697 PMID: 31068222 PMID: 29340058 PMID: 24840647 PMID: 29633005 PMID: 24463885 PMID: 26314780 PMID: 10353756 PMID: 27038273 PMID PMID: 298754 PMID: 298754 25358667 PMID: 17470860 PMID: 30739743 PMID: 23213101 PMID: 31118666 PMID: 26372905 PMID: 8889347 PMID: 25117729 PMID: 28324747 PMID: 21561347 PMID: 28427087 PMID: 29615310 PMID: 30620402 PMID PM25: 27228 PMID: 270228 : 9196156 PMID: 16508637 PMID: 9825730 PMID: 30348537 PMID: 30575490 PMID: 14998850 PMID: 24131140 PMID: 15297419 PMID: 28729048 PMID: 21919607

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