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Julien Péron, Pascal Roy, Thierry Conroy, Françoise Desseigne, Marc Ychou, Sophie Gourgou-Bourgade, Trevor Stanbury, Laurent Roche, Brice Ozenne, Marc Buyse
BACKGROUND: We sought to assess the benefit-risk balance of FOLFIRINOX versus gemcitabine in patients with metastatic pancreatic adenocarcinoma. METHODS: We used generalized pairwise comparisons. This statistical method permits the simultaneous analysis of several prioritized outcome measures. The first priority outcome was survival time (OS). Differences in OS that exceeded two months were considered clinically relevant. The second priority outcome was toxicity...
October 19, 2016: Oncotarget
H A Marsman, M G Besselink
- The incidence of pancreatic cancer is increasing due to the ageing population among other things, while 5-year survival has improved in the past two decades from 3 to 7%.- In case of biliary obstruction due to pancreatic cancer, biliary drainage before surgery or ablative therapy using a covered metal stent instead of plastic reduces the rate of complications.- In patients with metastasized pancreatic cancer a combination of folinic acid, fluorouracil, irinotecan and oxaliplatin (FOLFIRINOX) results in improved survival...
2016: Nederlands Tijdschrift Voor Geneeskunde
Florence K Keane, Jennifer Y Wo, Cristina R Ferrone, Jeffrey W Clark, Lawrence S Blaszkowsky, Jill N Allen, Eunice L Kwak, David P Ryan, Keith D Lillemoe, Carlos Fernandez-Del Castillo, Theodore S Hong
OBJECTIVES: Improved outcomes with FOLFIRINOX or gemcitabine with nab-paclitaxel in the treatment of metastatic pancreatic adenocarcinoma (PDAC) have prompted incorporation of these regimens into neoadjuvant treatment of locally advanced unresectable PDAC. Whereas some patients remain unresectable on surgical exploration, others are able to undergo resection after intensive neoadjuvant treatment. We evaluated outcomes and toxicity associated with use of intensive neoadjuvant treatment followed by intraoperative radiotherapy (IORT) in combination with resection or exploratory laparotomy...
October 12, 2016: American Journal of Clinical Oncology
Mišo Gostimir, Sean Bennett, Terence Moyana, Harman Sekhon, Guillaume Martel
BACKGROUND: Pancreatic cancer is among the top 5 most common cancers worldwide, but is particularly devastating due to its insidious nature. Complete surgical resection remains the only potential curative treatment, although only 20 % of patients present with a resectable tumor. Patients may alternatively present with borderline resectable pancreatic cancer or locally advanced pancreatic cancer and can be offered treatment with neoadjuvant intent. The effectiveness of these treatments is unclear and there is a paucity of data to suggest one optimal treatment approach...
October 10, 2016: BMC Cancer
A Hann, W Bohle, J Egger, W G Zoller
Background: New chemotherapeutic strategies for locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) have been shown to improve survival in randomized clinical trials. Little is known about the use of such chemotherapies and their benefit in community-based hospitals. This retrospective study analyzes the overall survival of these patients under "real life conditions" before and after the introduction of FOLFIRINOX in 2011. Methods: We retrospectively identified consecutive patients with PDAC who were treated at our hospital from 2011 to June 2014 (2011+ cohort) and 2004 to 2010 (historical cohort)...
October 2016: Zeitschrift Für Gastroenterologie
Uroosa Ibrahim, Divya Asti, Amina Saqib, Bindu Madhavi Mudduluru, Sadaf Ayaz, Marcel Odaimi
A case of pancreatic adenocarcinoma diagnosed following work up for eosinophilia is reported. A 68-year-old female was referred to our Hematology clinic for an absolute eosinophil count of 1869 per microliter. No allergic signs or symptoms were reported. Laboratory studies for parasitic infestations autoimmune disease and collagen vascular disease were negative. Computed tomography of the abdomen revealed a mass in the neck of the pancreas with fine needle aspiration biopsy consistent with adenocarcinoma. The patient received one cycle of modified FOLFIRINOX with complete resolution of the eosinophilia...
October 8, 2016: Postgraduate Medicine
Tulay Kus, Gokmen Aktas, Mehmet Emin Kalender, Alper Sevinc, Celaletdin Camci
PURPOSE: The aim of this retrospective study was to compare the different treatment options of patients with advanced biliary tract carcinoma (BTC) who were treated with platinum-gemcitabine (CG) or platinum-5-fluorouracil (CF) or 5-Fluorouracil-oxaliplatin-irinotecan (FOLFIRINOX) chemotherapy. METHODS: We included the patients with advanced BTC who were registered at the Department of Oncology in Gaziantep University between January 2008 and January 2016. The following data were analyzed: disease control rate (DCR), progression free survival (PFS) of first and second-line of chemotherapy, and overall survival (OS)...
October 6, 2016: Journal of Gastrointestinal Cancer
S J Rombouts, T H Mungroop, M N Heilmann, H W van Laarhoven, O R Busch, I Q Molenaar, M G Besselink, J W Wilmink
Introduction: FOLFIRINOX is emerging as new standard of care for fit patients with locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC). However, some of the physicians are reluctant to use FOLFIRINOX due to high toxicity rates reported in earlier studies. We reviewed our experience with FOLFIRINOX in LAPC and MPC, focussing on dose adjustments, toxicity and efficacy. Methods: We reviewed all patients with LAPC or MPC treated with FOLFIRINOX in our institution between April 2011 and December 2015...
2016: Journal of Cancer
Mahdi Gharaibeh, J Lyle Bootman, Ali McBride, Jennifer Martin, Ivo Abraham
Effect sizes of efficacy of first-line treatments for (metastatic) pancreas cancer are constrained, underscoring the need for evaluations of the efficacy-to-cost relationship. We critically review economic evaluations of first-line chemotherapy regimens for pancreatic cancer since the 1997 introduction of gemcitabine. We searched PubMed/MEDLINE and EMBASE (1997-2015), and the websites of health technology assessment agencies. Two authors independently reviewed economic studies for eligibility in this review; evaluated peer-reviewed, journal-published studies in terms of the Drummond Checklist; and critiqued the technical and scientific merit of all studies...
September 14, 2016: PharmacoEconomics
Yasuhiro Kaga, Yu Sunakawa, Yutaro Kubota, Teppei Tagawa, Taikan Yamamoto, Toshikazu Ikusue, Yu Uto, Kouichirou Miyashita, Hirokazu Toshima, Kouji Kobayashi, Atsushi Hisamatsu, Wataru Ichikawa, Takashi Sekikawa, Ken Shimada, Yasutsuna Sasaki
There are several reports on the correlation between early tumor shrinkage (ETS) or depth of response (DpR) and survival in chemotherapies for colorectal cancer; however, few studies have investigated it in pancreatic cancer. We therefore investigated whether the ETS will predict outcomes in 59 patients with advanced pancreatic cancer treated with FOLFIRINOX therapy. The association of ETS with progression-free survival (PFS) and overall survival (OS) was evaluated but also we addressed to the correlation between outcomes and DpR...
September 13, 2016: Oncotarget
Gauri R Varadhachary, Robert A Wolff
At present, front-line therapy for metastatic pancreatic ductal adenocarcinoma is combination chemotherapy, most commonly FOLFIRINOX (fluorouracil, irinotecan, and oxaliplatin) or gemcitabine and nanoparticle albumin-bound paclitaxel. Despite a better understanding of the genomic landscape and the importance of the tumor microenvironment, we have not made a seismic shift in the overall survival for this disease. Given our growing understanding of the biology of pancreatic ductal adenocarcinoma, the question remains whether novel, noncytotoxic agents will augment or even replace conventional chemotherapy...
September 2016: Journal of Oncology Practice
Chiara Caparello, Laura L Meijer, Ingrid Garajova, Alfredo Falcone, Tessa Y Le Large, Niccola Funel, Geert Kazemier, Godefridus J Peters, Enrico Vasile, Elisa Giovannetti
Pancreatic cancer is an extremely aggressive disease; although progress has been made in the last few years, the prognosis of these patients remains dismal. FOLFIRINOX is now considered a standard treatment in first-line setting, since it demonstrated an improved overall and progression-free survival vs gemcitabine alone. However, the enthusiasm over the benefit of this three-drug regimen is tempered by the associated increased toxicity profile, and many efforts have been made to improve the feasibility of this schedule...
August 21, 2016: World Journal of Gastroenterology: WJG
G Paul Wright, Katherine E Poruk, Mazen S Zenati, Jennifer Steve, Nathan Bahary, Melissa E Hogg, Amer H Zuriekat, Christopher L Wolfgang, Herbert J Zeh, Matthew J Weiss
INTRODUCTION: Patients with metastatic pancreatic adenocarcinoma have traditionally been offered palliative chemotherapy alone, and the role of surgery in these patients remains unknown. METHODS: A bi-institutional retrospective review was performed for patients with metastatic pancreatic adenocarcinoma who underwent resection of the primary tumor from 2008 to 2013. The primary outcome measured was postoperative overall survival. Secondary outcomes included postoperative disease-free survival and overall survival from the time of diagnosis...
September 7, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Sofia Westermark, Elena Rangelova, Christoph Ansorge, Lars Lundell, Ralf Segersvärd, Marco Del Chiaro
BACKGROUND: The recent development of new neo-adjuvant treatment regimens associated with a higher success rate of down-staging has increased the interest of pancreatic surgeons on the role of extended surgery for patients affected by locally advanced pancreatic cancer. Pancreatectomy together with resection of the portal/superior mesenteric vein is considered nowadays standard of care for patients affected by pancreatic cancer. However, the resection of major abdominal arteries is still debatable...
August 25, 2016: Langenbeck's Archives of Surgery
Amalia Azzariti, Oronzo Brunetti, Letizia Porcelli, Giusi Graziano, Rosa Maria Iacobazzi, Michele Signorile, Aldo Scarpa, Vito Lorusso, Nicola Silvestris
Pancreas ductal adenocarcinoma lacks predictive biomarkers. CD40 is a member of the tumor necrosis factor superfamily. CD40-sCD40L interaction is considered to contribute to the promotion of tumor cell growth and angiogenesis. The aim of the present study was to investigate the role of serum sCD40L as a predictor in metastatic pancreatic cancer. We evaluated 27 consecutive pancreatic cancer patients treated with FOLFIRINOX (21 patients) or gemcitabine plus nab-paclitaxel combination (six patients). The sCD40L level was measured in serum by enzyme-linked immunosorbent assay at baseline, at first evaluation (all patients), and at time to progression (18 patients)...
2016: OncoTargets and Therapy
Ken-Ichi Okada, Manabu Kawai, Seiko Hirono, Sohei Satoi, Hiroaki Yanagimoto, Tatsuya Ioka, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata, Hiroki Yamaue
PURPOSE: The aim of this pilot study is to confirm the safety and efficacy of neoadjuvant therapy and also treatment duration efficacy using modified FOLFIRINOX for patients with borderline resectable pancreatic cancer (BRPC). METHODS: The study is a prospective multicenter pilot trial conducted on patients with BRPC. Intervention for clinical trials: Modified FOLFIRINOX (without bolus 5-FU and LV, also decreased the dose of irinotecan; FIRINOX) was given to the first five patients in the 4-cycle group of the regimen and next five patients in the 8-cycle group...
October 2016: Cancer Chemotherapy and Pharmacology
Walid L Shaib, Natalyn Hawk, Richard J Cassidy, Zhengjia Chen, Chao Zhang, Edith Brutcher, David Kooby, Shishir K Maithel, Juan M Sarmiento, Jerome Landry, Bassel F El-Rayes
PURPOSE: A challenge in borderline resectable pancreatic cancer (BRPC) management is the high rate of positive posterior margins (PM). Stereotactic body radiation therapy (SBRT) allows for higher radiation delivery dose with conformity. This study evaluated the maximal tolerated dose with a dose escalation plan level up to 45 Gy using SBRT in BRPC. METHODS AND MATERIALS: A single-institution, 3 + 3 phase 1 clinical trial design was used to evaluate 4 dose levels of SBRT delivered in 3 fractions to the planning target volume (PTV) with a simultaneous in-field boost (SIB) to the PM...
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Muralidharan K Chllamma, Natalie Cook, Neesha C Dhani, Kazim Giby, Anna Dodd, Lisa Wang, David W Hedley, Malcolm J Moore, Jennifer J Knox
BACKGROUND: FOLFIRINOX has been shown to significantly increase both overall survival (OS) and progression-free survival (PFS) in metastatic pancreas cancer. There is limited data regarding the treatment of locally advanced pancreatic cancer. We present a retrospective study of patients with both locally advanced and metastatic pancreas cancer using FOLFIRINOX as first-line therapy in our centre. METHODS: This is a retrospective review of patients treated with FOLFIRINOX for pancreatic cancer at Princess Margaret Cancer Centre, between December 2011 and July 2014...
September 6, 2016: British Journal of Cancer
Sunhee S Kim, Eric K Nakakura, Zhen J Wang, Grace E Kim, Carlos U Corvera, Hobart W Harris, Kimberly S Kirkwood, Ryutaro Hirose, Margaret A Tempero, Andrew H Ko
BACKGROUND: No consensus exists regarding the optimal neoadjuvant treatment paradigm for patients with borderline resectable pancreatic cancer (BRPC), including the respective roles of chemotherapy and radiation. METHODS: We performed a retrospective analysis, including detailed pathologic and radiologic review, of pancreatic cancer patients undergoing FOLFIRINOX, with or without radiation therapy (RT), prior to surgical resection at a high-volume academic center over a 4-year period...
October 2016: Journal of Surgical Oncology
Volker Ellenrieder, Alexander König, Thomas Seufferlein
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy with a median 5-year survival of <8%. At the time of diagnosis, a vast majority of pancreatic cancer patients were found to be with either metastatic spread of the disease or locally advanced tumors. Despite relatively low efficacy, gemcitabine administration was the first choice chemotherapeutic strategy in advanced PDAC for many years. In the last 5 years, however, our understanding of pancreatic carcinogenesis has improved dramatically and with this our therapeutic options have expanded significantly...
2016: Digestion
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