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FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer

Thierry Conroy 1 Pascal Hammel 2 Mohamed Hebbar 3 Meher Ben Abdelghani 4 Alice Wei Jean-Luc Raoul 5 Laurence Choné 6 Eric Francois 7 Pascal Artru 8 James Biagi Thierry Lecomte 9 Eric Assenat 10, 11 Roger Faroux 12 Marc Ychou 13 Julien Volet 14 Alain Sauvanet 15 Gilles Breysacher 16 Frédéric Di Fiore 17 Christine Cripps Petr Kavan Patrick Texereau 18 Karine Bouhier-Leporrier 19 Faiza Khemissa-Akouz 20 Jean-Louis Legoux 21 Beata Juzyna 22 Sophie Gourgou 13 Christopher O'Callaghan Claire Jouffroy-Zeller 22 Patrick Rat 23 David Malka 24 Florence Castan 13 Jean-Baptiste Bachet 25 Canadian Cancer Trials Group Unicancer-Gi–prodige Group
Abstract : BACKGROUND: Among patients with metastatic pancreatic cancer, combination chemotherapy with fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) leads to longer overall survival than gemcitabine therapy. We compared the efficacy and safety of a modified FOLFIRINOX regimen with gemcitabine as adjuvant therapy in patients with resected pancreatic cancer. METHODS: We randomly assigned 493 patients with resected pancreatic ductal adenocarcinoma to receive a modified FOLFIRINOX regimen (oxaliplatin [85 mg per square meter of body-surface area], irinotecan [180 mg per square meter, reduced to 150 mg per square meter after a protocol-specified safety analysis], leucovorin [400 mg per square meter], and fluorouracil [2400 mg per square meter] every 2 weeks) or gemcitabine (1000 mg per square meter on days 1, 8, and 15 every 4 weeks) for 24 weeks. The primary end point was disease-free survival. Secondary end points included overall survival and safety. RESULTS: At a median follow-up of 33.6 months, the median disease-free survival was 21.6 months in the modified-FOLFIRINOX group and 12.8 months in the gemcitabine group (stratified hazard ratio for cancer-related event, second cancer, or death, 0.58; 95% confidence interval [CI], 0.46 to 0.73; P<0.001). The disease-free survival rate at 3 years was 39.7% in the modified-FOLFIRINOX group and 21.4% in the gemcitabine group. The median overall survival was 54.4 months in the modified-FOLFIRINOX group and 35.0 months in the gemcitabine group (stratified hazard ratio for death, 0.64; 95% CI, 0.48 to 0.86; P=0.003). The overall survival rate at 3 years was 63.4% in the modified-FOLFIRINOX group and 48.6% in the gemcitabine group. Adverse events of grade 3 or 4 occurred in 75.9% of the patients in the modified-FOLFIRINOX group and in 52.9% of those in the gemcitabine group. One patient in the gemcitabine group died from toxic effects (interstitial pneumonitis). CONCLUSIONS: Adjuvant therapy with a modified FOLFIRINOX regimen led to significantly longer survival than gemcitabine among patients with resected pancreatic cancer, at the expense of a higher incidence of toxic effects. (Funded by R&D Unicancer and others; number, NCT01526135 ; EudraCT number, 2011-002026-52 .).
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Soumis le : lundi 9 septembre 2019 - 13:34:07
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Thierry Conroy, Pascal Hammel, Mohamed Hebbar, Meher Ben Abdelghani, Alice Wei, et al.. FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer. New England Journal of Medicine, Massachusetts Medical Society, 2018, 379 (25), pp.2395-2406. ⟨10.1056/NEJMoa1809775⟩. ⟨hal-02281628⟩



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