Division of Hepato-Biliary-Pancreatic Medicine, Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
BMC Cancer. 2020 May 20;20(1):449. doi: 10.1186/s12885-020-06945-8.
There is no established second-line treatment after failure of gemcitabine plus nab-paclitaxel (GnP) therapy for metastatic pancreatic cancer (MPC). The purpose of this study was to evaluate the efficacy and tolerability of the modified FOLFIRINOX (mFFX) as a second-line therapy for MPC and to investigate prognostic factors for survival.
From 2015 to 2019, we retrospectively reviewed the medical records of consecutive patients receiving mFFX for MPC after failure of GnP therapy. Patients were treated every 2 weeks with mFFX (intravenous oxaliplatin 85 mg/m, intravenous irinotecan 150 mg/m, and continuous infusion of 5-fluorouracil 2400 mg/m for 46 h without bolus infusion).
In total, 104 patients received mFFX. The median overall survival (OS) was 7.0 months (95% confidence interval [CI]: 6.2-9.8) and the progression-free survival (PFS) 3.9 months (95% CI 2.8-5.0). The objective response rate was 10.6% and the disease control rate 56.7%. The median relative dose intensities of oxaliplatin, irinotecan, and infusional 5-FU were 80.0% (range 21.5-100%), 77.2% (range 38.1-100%), and 85.9% (range 36.9-100%), respectively. Grade 3-4 toxicities were reported in 57 patients (54.8%), including neutropenia, leukopenia, anemia, febrile neutropenia, and peripheral sensory neuropathy. Glasgow prognostic score and carcinoembryonic antigen level were independently associated with survival. Our prognostic model using these parameters could classify the patients into good (n = 38), intermediate (n = 47), and poor (n = 19) prognostic groups. The median OS and PFS time was 14.7 (95% CI 7.6-16.3) and 7.6 months (95% CI 4.1-10.5) for the good prognostic factors, 6.5 (95% CI 5.5-10.0) and 3.6 months (95% CI 2.7-4.8) for the intermediate prognostic factors and 5.0 (95% CI 2.9-6.6) and 1.7 months (95% CI 0.9-4.3) for the poor prognostic factors, respectively.
The mFFX showed to be a tolerable second-line treatment for MPC after GnP failure. Our prognostic model might be useful for deciding whether mFFX is indicated in this setting.
吉西他滨联合 nab-紫杉醇（GnP）治疗转移性胰腺癌（MPC）失败后，尚无既定的二线治疗方法。本研究旨在评估改良 FOLFIRINOX（mFFX）作为 MPC 二线治疗的疗效和耐受性，并探讨生存的预后因素。
2015 年至 2019 年，我们回顾性分析了连续接受 GnP 治疗失败后接受 mFFX 治疗的 MPC 患者的病历。患者每 2 周接受 mFFX 治疗（静脉注射奥沙利铂 85mg/m2、静脉注射伊立替康 150mg/m2 和连续输注氟尿嘧啶 2400mg/m246 小时，无推注）。
共有 104 例患者接受 mFFX 治疗。中位总生存期（OS）为 7.0 个月（95%置信区间 [CI]：6.2-9.8），无进展生存期（PFS）为 3.9 个月（95%CI：2.8-5.0）。客观缓解率为 10.6%，疾病控制率为 56.7%。奥沙利铂、伊立替康和氟尿嘧啶输注的中位相对剂量强度分别为 80.0%（范围 21.5-100%）、77.2%（范围 38.1-100%）和 85.9%（范围 36.9-100%）。57 例（54.8%）患者出现 3-4 级毒性反应，包括中性粒细胞减少症、白细胞减少症、贫血、发热性中性粒细胞减少症和周围感觉神经病。格拉斯哥预后评分和癌胚抗原水平与生存独立相关。我们使用这些参数的预后模型可以将患者分为良好（n=38）、中等（n=47）和差（n=19）预后组。对于良好预后因素，中位 OS 和 PFS 时间分别为 14.7（95%CI 7.6-16.3）和 7.6 个月（95%CI 4.1-10.5）；对于中等预后因素，中位 OS 和 PFS 时间分别为 6.5（95%CI 5.5-10.0）和 3.6 个月（95%CI 2.7-4.8）；对于差预后因素，中位 OS 和 PFS 时间分别为 5.0（95%CI 2.9-6.6）和 1.7 个月（95%CI 0.9-4.3）。
mFFX 作为 GnP 治疗失败后的二线治疗方法是可以耐受的。我们的预后模型可能有助于决定是否在这种情况下使用 mFFX。
