Metastatic Pancreatic Cancer

Posted by Graham McMahon • May 13th, 2011

In a new study from Conroy et al., a four-drug combination chemotherapy regimen was associated with objective responses in more than 30% of patients and increased survival by more than 4 months, as compared with standard gemcitabine.

Pancreatic adenocarcinoma was the fourth leading cause of death from cancer in the United States in 2010, and it carries a grim prognosis.

Clinical Pearls

As compared to gemcitabine alone, what effect did FOLFIRINOX treatment have on survival?

The median overall survival was 11.1 months in the FOLFIRINOX group as compared with 6.8 months in the gemcitabine group (hazard ratio for death, 0.57; 95% confidence interval [CI], 0.45 to 0.73; P<0.001).

As compared to gemcitabine alone, what effect did FOLFIRINOX treatment have on quality of life?

At 6 months, 31% of the patients in the FOLFIRINOX group had a definitive degradation of the global health-related quality of life versus 66% in the gemcitabine group (hazard ratio, 0.47; 95% CI, 0.30 to 0.70; P<0.001).

Table 2. Objective Responses in the Intention-to-Treat Population.

Morning Report Questions

Q: What adverse effects were associated with FOLFIRINOX treatment?

A: The incidence of grade 3 or 4 neutropenia, febrile neutropenia, thrombocytopenia, diarrhea, and sensory neuropathy, as well as grade 2 alopecia, was significantly higher in the FOLFIRINOX group, whereas the incidence of grade 3 or 4 elevated alanine aminotransferase levels was significantly higher in the gemcitabine group.

Q: What factors were identified as independent adverse prognostic factors in this study?

A: Synchronous metastases, a low baseline albumin level (<3.5 g per deciliter), hepatic metastases, and an age of more than 65 years were identified as independent adverse prognostic factors for overall survival in this study.

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