FOLFOXIRI vs FOLFIRINOX as first-line chemotherapy in patients with advanced pancreatic cancer: A population-based cohort study

doi:10.4251/wjgo.v12.i3.332

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World Journal of Gastrointestinal Oncology

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World J Gastrointest Oncol. Mar 15, 2020; 12(3): 332-346
Published online Mar 15, 2020. doi: 10.4251/wjgo.v12.i3.332

FOLFOXIRI vs FOLFIRINOX as first-line chemotherapy in patients with advanced pancreatic cancer: A population-based cohort study

Dewi Vernerey, Christophe Borg, Anthony Turpin, Syrine Abdeljaoued, Meher Nasri, Francine Fein, Hamadi Almotlak, Fabien Calcagno, Thierry Nguyen, Christelle d’Engremont, Stefano Kim, Marine Jary, Aurélia Meurisse, Elodie Klajer, Elisabeta Gherga, Clément Bolognini, Hortense Chevalier, Angélique Vienot

Angélique Vienot, Clément Bolognini, Elodie Klajer, Marine Jary, Stefano Kim, Thierry Nguyen, Fabien Calcagno, Hamadi Almotlak, Christophe Borg, Department of Medical Oncology, Besançon University Hospital, Besançon F-25030, France

Angélique Vienot, Aurélia Meurisse, Marine Jary, Stefano Kim, Syrine Abdeljaoued, Christophe Borg, Dewi Vernerey, University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon F-25000, France

Angélique Vienot, Marine Jary, Stefano Kim, Christophe Borg, INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Besançon University Hospital, Besançon F-25030, France

Hortense Chevalier, Anthony Turpin, Department of Medical Oncology, Lille University Hospital, Lille F-59000, France

Elisabeta Gherga, Meher Nasri, Department of Medical Oncology, Nord Franche-Comté Hospital, Montbéliard F-25020, France

Aurélia Meurisse, Dewi Vernerey, Methodological and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon F-25030, France

Christelle d’Engremont, Francine Fein, Department of Gastroenterology, Besançon University Hospital, Besançon F-25030, France

Author contributions: Vienot A, Borg C, Vernerey D contributed to conception and design; Vienot A, Chevalier H, Bolognini C, Gherga E, Klajer E, Jary M, Kim S, d’Engremont C, Nguyen T, Calcagno F, Almotlak H, Fein F, Nasri M, Turpin A, Borg C contributed to collection and assembly of data. Vienot A, Meurisse A, Vernerey D contributed to statistical analyses. Vienot A, Chevalier H, Turpin A, Borg C, Vernerey D contributed to data interpretation. Vienot A, Chevalier H, Abdeljaoued S, Turpin A, Borg C, Vernerey D contributed to manuscript writing; all authors read and approved the final manuscript.

Institutional review board statement: This project was approved by the National French Commission for bioinformatics data and patient liberty (CNIL; No. of CNIL declaration: 1906173 v 0).

Informed consent statement: A written informed consent form was provided by all patients.

Conflict-of-interest statement: No author has any conflict of interest.

STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.

Corresponding author: Angélique Vienot, MD, Department of Medical Oncology, Besançon University Hospital, 3 Boulevard Alexandre Fleming, Besançon F-25030, France. angelique.vienot@inserm.fr

Received: August 24, 2019
Peer-review started: August 24, 2019
First decision: October 18, 2019
Revised: December 26, 2019
Accepted: January 14, 2020
Article in press: January 14, 2020
Published online: March 15, 2020
Processing time: 200 Days and 19 Hours

ARTICLE HIGHLIGHTS

Research background

The FOLFIRINOX regimen is the first-line reference chemotherapy (L1) in advanced pancreatic ductal adenocarcinoma (PDAC). FOLFOXIRI might contribute to a better balance in the toxicity/efficacy ratio in this setting.

Research motivation

FOLFOXIRI has demonstrated efficacy and feasibility in colorectal cancer.

Research objectives

To investigate the potential clinical value of FOLFOXIRI in patients with advanced PDAC (aPDAC) in routine clinical practice.

Research methods

This exploratory study compared clinical outcomes between the two treatments in the overall population and after propensity score matching.

Research results

All consecutive aPDAC patients treated in L1 with FOLFOXIRI (n = 165) or FOLFIRINOX (n = 124) regimens were included. Median overall survival was 11.1 mo in the FOLFOXIRI cohort and 11.6 mo in the FOLFIRINOX cohort. After propensity score matching, survival rates remained similar between the regimens in terms of overall survival and progression-free survival. FOLFOXIRI was associated with a higher incidence of grade 3/4 digestive adverse events. The low hematological toxicity rates in both regimens underline the relevance of primary prophylaxis with hematopoietic growth factors.

Research conclusions

FOLFOXIRI is feasible in L1 in patients with aPDAC but does not confer any therapeutic benefit as compared with FOLFIRINOX.

Research perspectives

These results suggest that further evaluation of FOLFOXIRI in future clinical trials is not warranted. FOLFIRINOX chemotherapy remains the standard of care in L1 in metastatic PDAC.