Foschini Francesca, Napolitano Fabiana, Servetto Alberto, Marciano Roberta, Mozzillo Eleonora, Carratù Anna Chiara, Santaniello Antonio, De Placido Pietro, Cascetta Priscilla, Butturini Giovanni, Frigerio Isabella, Regi Paolo, Silvestris Nicola, Delcuratolo Sabina, Vasile Enrico, Vivaldi Caterina, Bianco Cataldo, De Placido Sabino, Formisano Luigi, Bianco Roberto
Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, 80131 Naples, Italy.
Pancreatic Surgery Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy.
Ther Adv Med Oncol. 2020 Sep 29;12:1758835920947970. doi: 10.1177/1758835920947970. eCollection 2020.
Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death. In cases with metastasis, the combination of 5-fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) or gemcitabine-based chemotherapy regimens are considered the standard of care. However, the optimal sequence of these regimens is unclear.
This retrospective study initially evaluated 186 patients with locally advanced/metastatic pancreatic cancer at three Italian institutions between February 2013 and October 2019. All patients had progressed after receiving gemcitabine-based first-line chemotherapy and were subsequently offered second-line FOLFIRINOX, FOLFOX-6, or FOLFIRI treatment. This study evaluated progression-free survival (PFS), overall survival from the start of second-line treatment (OS2), overall survival from the start of first-line treatment (OS1), and safety outcomes.
A total of 77 patients received ⩾4 cycles of second-line chemotherapy and were considered eligible: 15 patients received FOLFIRINOX, 32 patients received FOLFOX-6, and 30 patients received FOLFIRI. The FOLFIRINOX group had median PFS of 26.29 weeks and median OS2 of 47.86 weeks, while the FOLFIRI group had median PFS of 10.57 weeks and median OS2 of 25.00 weeks ( = 0.038). No significant differences were observed between the FOLFIRINOX and FOLFOX-6 groups in terms of PFS (26.29 weeks 23.07 weeks) or OS2 (47.86 weeks 42.00 weeks). The most common grade 3-4 toxicities were anemia, neutropenia, and thrombocytopenia, which occurred more frequently in the FOLFIRINOX and FOLFOX-6 groups.
Relative to the FOLFIRI regimen, the FOLFIRINOX regimen had a favorable toxicity profile and better survival outcomes. No significant differences were observed relative to the FOLFOX-6 regimen.
胰腺腺癌是癌症相关死亡的第四大主要原因。在发生转移的病例中，氟尿嘧啶、伊立替康和奥沙利铂联合方案（FOLFIRINOX）或基于吉西他滨的化疗方案被视为标准治疗方案。然而，这些方案的最佳顺序尚不清楚。
这项回顾性研究最初评估了2013年2月至2019年10月期间在意大利三家机构的186例局部晚期/转移性胰腺癌患者。所有患者在接受基于吉西他滨的一线化疗后病情进展，随后接受二线FOLFIRINOX、FOLFOX-6或FOLFIRI治疗。本研究评估了无进展生存期（PFS）、二线治疗开始后的总生存期（OS2）、一线治疗开始后的总生存期（OS1）以及安全性结果。
共有77例患者接受了≥4周期的二线化疗并被视为符合条件：15例患者接受FOLFIRINOX，32例患者接受FOLFOX-6，30例患者接受FOLFIRI。FOLFIRINOX组的中位PFS为26.29周，中位OS2为47.86周，而FOLFIRI组的中位PFS为10.57周，中位OS2为25.00周（P = 0.038）。FOLFIRINOX组和FOLFOX-6组在PFS（26.29周对23.07周）或OS2（47.86周对42.00周）方面未观察到显著差异。最常见的3-4级毒性反应是贫血、中性粒细胞减少和血小板减少，在FOLFIRINOX组和FOLFOX-⑥组中发生得更频繁。
相对于FOLFIRI方案，FOLFIRINOX方案具有良好的毒性特征和更好的生存结果。相对于FOLFOX-6方案未观察到显著差异。
