FOLFIRI regimen in metastatic pancreatic adenocarcinoma resistant to gemcitabine and platinum-salts

作     者：Cindy Neuzillet Olivia Hentic Benot Rousseau Vinciane Rebours Léla Bengrine-Lefèvre Franck Bonnetain Philippe Lévy Eric Raymond Philippe Ruszniewski Christophe Louvet Pascal Hammel 

作者机构：Service de Gastroentérologie-Pancréatologie Hpital Beaujon 100 Boul-evard du Général Leclerc 92110 Clichy La Garenne AP-HP France Service d'Oncologie Médicale Hpital Saint Antoine 184 Rue du Faubourg Saint-Antoine 75012 Paris AP-HP France Unité de Biostatistique et d'Epidémiologie EA 4184 Centre Georges Franois Leclerc 1 Rue du Pr Marion 21079 Dijon France Service d'Oncologie Médicale Hpital Beau-jon 100 Boulevard du Général Leclerc 92110 Clichy La Garenne AP-HP France Département d'Oncologie Médicale Institut Mutualiste Montsouris 42 Boulevard Jourdan 75014 Paris France 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2012年第18卷第33期

页      面：4533-4541页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Pancreatic cancer Pancreatic adenocarcinoma Metastases Chemotherapy 5 fluorouracil Irinotecan Camptothecin FOLFIRI regimen 

摘      要：AIM: To evaluate the efficacy and safety of the FOLFIRI regimen in patients with metastatic pancreatic adenocarcinoma (PAC) after the failure of gemcitabine and platinum salts. METHODS: All consecutive patients with histologically confirmed, metastatic PAC and World Health Organiza-tion performance status (PS) ≤ 2 received FOLFIRI-1 [irinotecan 180 mg/m2 on day 1 and leucovorin 400 mg/m2 followed by 5-fluorouracil (5-FU) 400 mg/m2 bolus, then 5-FU 2400 mg/m2 as a 46-h infusion, biweekly] or FOLFIRI-3 (irinotecan 100 mg/m2 on day 1 and leucovorin 400 mg/m2, then 5-FU 2400 mg/m2 as a 46-h infusion and irinotecan 100 mg/m2 repeated on day 3, biweekly) after failure of gemcitabine and platinum-based chemotherapies as a systematic policy in two institutions between January 2005 and May 2010. Tumor response, time to progression (TTP), overall survival rate (OS) and grade 3-4 toxicities were retrospectively studied. Subgroup analyses were performed to search for prognostic factors. RESULTS: Sixty-three patients (52.4% male, median age 59 years) were analyzed. Among them, 42.9% were PS 0, 38.1% were PS 1 and 19.0% were PS 2. Fifty one patients (81.0%) had liver metastases. Before the FOLFIRI regimen, patients had received 1 line (n = 19), 2 lines (n = 39) or 3 lines (n = 5) of chemotherapy. Median TTP obtained with the line before FOLFIRI was 3.9 mo (95% CI: 3.4-5.3 mo). A total of 480 cycles was completed (median: 6 cycles, range: 1-51 cycles). The main reason for discontinuing FOLFIRI was tumor progression (90.3%). Tumor control was achieved in 25 patients (39.7%) (partial response: n = 5, stable disease: n = 20) with FOLFIRI. Median TTP was 3.0 mo (95% CI: 2.1-3.9 mo) and median OS was 6.6 mo (95% CI: 5.3-8.1 mo). Dose adaptation was required in 36 patients (57.1%). Fifteen patients (23.8%) had grade 3-4 toxicities, mainly hematological (n = 11) or digestive (n = 4). Febrile neutropenia occurred in 3 patients. There was no toxic death. PS 2 was significantly associated w