TY - JOUR
T1 - FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer
AU - Conroy, T.
AU - Hammel, P.
AU - Hebbar, M.
AU - Ben Abdelghani, M.
AU - Wei, A. C.
AU - Raoul, J. L.
AU - Choné, L.
AU - Francois, E.
AU - Artru, P.
AU - Biagi, J. J.
AU - Lecomte, T.
AU - Assenat, E.
AU - Faroux, R.
AU - Ychou, M.
AU - Volet, J.
AU - Sauvanet, A.
AU - Breysacher, G.
AU - Di Fiore, F.
AU - Cripps, C.
AU - Kavan, P.
AU - Texereau, P.
AU - Bouhier-Leporrier, K.
AU - Khemissa-Akouz, F.
AU - Legoux, J. L.
AU - Juzyna, B.
AU - Gourgou, S.
AU - O'Callaghan, C. J.
AU - Jouffroy-Zeller, C.
AU - Rat, P.
AU - Malka, D.
AU - Castan, F.
AU - Bachet, J. B.
N1 - Publisher Copyright:
© 2018 Massachusetts Medical Society.
PY - 2018/12/20
Y1 - 2018/12/20
N2 - 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 bodysurface 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.
AB - 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 bodysurface 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.
UR - http://www.scopus.com/inward/record.url?scp=85058900494&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa1809775
DO - 10.1056/NEJMoa1809775
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 30575490
AN - SCOPUS:85058900494
SN - 0028-4793
VL - 379
SP - 2395
EP - 2406
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 25
ER -
