FOLFOX regimen after failure of fluorouracil and leucovorin plus nanoliposomal-irinotecan therapy for advanced pancreatic cancer: a retrospective observational study
Abstract Background Fluorouracil, leucovorin (5FU/LV), and nanoliposomal-irinotecan (nal-IRI) combination therapy has been established as the second-line treatment for advanced pancreatic ductal adenocarcinoma. Oxaliplatin with 5FU/LV (FOLFOX) is often used as a subsequent treatment, although its ef...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Cancer |
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| Online Access: | https://doi.org/10.1186/s12885-023-10654-3 |
| _version_ | 1827983873900806144 |
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| author | Satoshi Kobayashi Shun Tezuka Yui Yamachika Shotaro Tsunoda Shuhei Nagashima Yuichiro Tozuka Taito Fukushima Manabu Morimoto Makoto Ueno Junji Furuse Shin Maeda |
| author_facet | Satoshi Kobayashi Shun Tezuka Yui Yamachika Shotaro Tsunoda Shuhei Nagashima Yuichiro Tozuka Taito Fukushima Manabu Morimoto Makoto Ueno Junji Furuse Shin Maeda |
| author_sort | Satoshi Kobayashi |
| collection | DOAJ |
| description | Abstract Background Fluorouracil, leucovorin (5FU/LV), and nanoliposomal-irinotecan (nal-IRI) combination therapy has been established as the second-line treatment for advanced pancreatic ductal adenocarcinoma. Oxaliplatin with 5FU/LV (FOLFOX) is often used as a subsequent treatment, although its efficacy and safety are yet to be fully elucidated. We aimed to evaluate the efficacy and safety of FOLFOX as a third- or later-line treatment for patients with advanced pancreatic ductal adenocarcinoma. Methods We conducted a single-centre, retrospective study that enrolled 43 patients who received FOLFOX after failure of gemcitabine-based regimen followed by 5FU/LV + nal-IRI therapy between October 2020 and January 2022. FOLFOX therapy consisted of oxaliplatin (85 mg/m2), levo-leucovorin calcium (200 mg/m2) and 5-FU (2400 mg/m2) every 2 weeks per cycle. Overall survival, progression-free survival, objective response, and adverse events were evaluated. Results At the median follow-up time of 3.9 months in all patients, the median overall survival and progression-free survival were 3.9 months (95% confidence interval [CI], 3.1–4.8) and 1.3 months (95% CI, 1.0–1.5), respectively. Response and disease control rates were 0 and 25.6%, respectively. The most common adverse event was anaemia in all grades followed by anorexia; the incidence of anorexia and grades 3 and 4 was 21 and 4.7%, respectively. Notably, grades 3–4 peripheral sensory neuropathy was not observed. Multivariable analysis revealed that a C-reactive protein (CRP) level of > 1.0 mg/dL was a poor prognostic factor for both progression-free survival and overall survival: hazard ratios were 2.037 (95% CI, 1.010–4.107; p = 0.047) and 2.471 (95% CI, 1.063–5.745; p = 0.036), respectively. Conclusion FOLFOX as a subsequent treatment after failure of second-line treatment with 5FU/LV + nal-IRI is tolerable, although its efficacy is limited, particularly in patients with high CRP levels. |
| first_indexed | 2024-04-09T22:53:04Z |
| format | Article |
| id | doaj.art-9f393b00e3684232980b379d7f04bd55 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-04-09T22:53:04Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-9f393b00e3684232980b379d7f04bd552023-03-22T11:34:45ZengBMCBMC Cancer1471-24072023-02-012311810.1186/s12885-023-10654-3FOLFOX regimen after failure of fluorouracil and leucovorin plus nanoliposomal-irinotecan therapy for advanced pancreatic cancer: a retrospective observational studySatoshi Kobayashi0Shun Tezuka1Yui Yamachika2Shotaro Tsunoda3Shuhei Nagashima4Yuichiro Tozuka5Taito Fukushima6Manabu Morimoto7Makoto Ueno8Junji Furuse9Shin Maeda10Department of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Kanagawa Cancer CenterDepartment of Gastroenterology, Yokohama City University Graduate School of MedicineAbstract Background Fluorouracil, leucovorin (5FU/LV), and nanoliposomal-irinotecan (nal-IRI) combination therapy has been established as the second-line treatment for advanced pancreatic ductal adenocarcinoma. Oxaliplatin with 5FU/LV (FOLFOX) is often used as a subsequent treatment, although its efficacy and safety are yet to be fully elucidated. We aimed to evaluate the efficacy and safety of FOLFOX as a third- or later-line treatment for patients with advanced pancreatic ductal adenocarcinoma. Methods We conducted a single-centre, retrospective study that enrolled 43 patients who received FOLFOX after failure of gemcitabine-based regimen followed by 5FU/LV + nal-IRI therapy between October 2020 and January 2022. FOLFOX therapy consisted of oxaliplatin (85 mg/m2), levo-leucovorin calcium (200 mg/m2) and 5-FU (2400 mg/m2) every 2 weeks per cycle. Overall survival, progression-free survival, objective response, and adverse events were evaluated. Results At the median follow-up time of 3.9 months in all patients, the median overall survival and progression-free survival were 3.9 months (95% confidence interval [CI], 3.1–4.8) and 1.3 months (95% CI, 1.0–1.5), respectively. Response and disease control rates were 0 and 25.6%, respectively. The most common adverse event was anaemia in all grades followed by anorexia; the incidence of anorexia and grades 3 and 4 was 21 and 4.7%, respectively. Notably, grades 3–4 peripheral sensory neuropathy was not observed. Multivariable analysis revealed that a C-reactive protein (CRP) level of > 1.0 mg/dL was a poor prognostic factor for both progression-free survival and overall survival: hazard ratios were 2.037 (95% CI, 1.010–4.107; p = 0.047) and 2.471 (95% CI, 1.063–5.745; p = 0.036), respectively. Conclusion FOLFOX as a subsequent treatment after failure of second-line treatment with 5FU/LV + nal-IRI is tolerable, although its efficacy is limited, particularly in patients with high CRP levels.https://doi.org/10.1186/s12885-023-10654-3OxaliplatinFOLFOXThird-line treatmentSalvageCRPHomologous recombination deficiency |
| spellingShingle | Satoshi Kobayashi Shun Tezuka Yui Yamachika Shotaro Tsunoda Shuhei Nagashima Yuichiro Tozuka Taito Fukushima Manabu Morimoto Makoto Ueno Junji Furuse Shin Maeda FOLFOX regimen after failure of fluorouracil and leucovorin plus nanoliposomal-irinotecan therapy for advanced pancreatic cancer: a retrospective observational study BMC Cancer Oxaliplatin FOLFOX Third-line treatment Salvage CRP Homologous recombination deficiency |
| title | FOLFOX regimen after failure of fluorouracil and leucovorin plus nanoliposomal-irinotecan therapy for advanced pancreatic cancer: a retrospective observational study |
| title_full | FOLFOX regimen after failure of fluorouracil and leucovorin plus nanoliposomal-irinotecan therapy for advanced pancreatic cancer: a retrospective observational study |
| title_fullStr | FOLFOX regimen after failure of fluorouracil and leucovorin plus nanoliposomal-irinotecan therapy for advanced pancreatic cancer: a retrospective observational study |
| title_full_unstemmed | FOLFOX regimen after failure of fluorouracil and leucovorin plus nanoliposomal-irinotecan therapy for advanced pancreatic cancer: a retrospective observational study |
| title_short | FOLFOX regimen after failure of fluorouracil and leucovorin plus nanoliposomal-irinotecan therapy for advanced pancreatic cancer: a retrospective observational study |
| title_sort | folfox regimen after failure of fluorouracil and leucovorin plus nanoliposomal irinotecan therapy for advanced pancreatic cancer a retrospective observational study |
| topic | Oxaliplatin FOLFOX Third-line treatment Salvage CRP Homologous recombination deficiency |
| url | https://doi.org/10.1186/s12885-023-10654-3 |
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