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folfirinox for pancreatic cancer

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https://www.readbyqxmd.com/read/29227344/predictors-of-resectability-and-survival-in-patients-with-borderline-and-locally-advanced-pancreatic-cancer-who-underwent-neoadjuvant-treatment-with-folfirinox
#1
Theodoros Michelakos, Ilaria Pergolini, Carlos Fernández-Del Castillo, Kim C Honselmann, Lei Cai, Vikram Deshpande, Jennifer Y Wo, David P Ryan, Jill N Allen, Lawrence S Blaszkowsky, Jeffrey W Clark, Janet E Murphy, Ryan D Nipp, Aparna Parikh, Motaz Qadan, Andrew L Warshaw, Theodore S Hong, Keith D Lillemoe, Cristina R Ferrone
OBJECTIVE: The aim of this study was to determine (1) whether preoperative factors can predict resectability of borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant FOLFIRINOX, (2) which patients might benefit from adjuvant therapy, and (3) survival differences between resected BR/LA patients who received neoadjuvant FOLFIRINOX and upfront resected patients. BACKGROUND: Patients with BR/LA PDAC are often treated with FOLFIRINOX to obtain a margin-negative resection, yet selection of patients for resection remains challenging...
December 7, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/29221990/molecular-and-cellular-mechanisms-of-chemoresistance-in-pancreatic-cancer
#2
REVIEW
Aleksandra Adamska, Omar Elaskalani, Aikaterini Emmanouilidi, Minkyoung Kim, Norbaini Binti Abdol Razak, Pat Metharom, Marco Falasca
Pancreatic Ductal Adenocarcinoma (PDAC) is one of the most chemoresistant cancers, and current therapies targeting cancer-associated molecular pathways have not given satisfactory results, owing in part to rapid upregulation of alternative compensatory pathways. Most of the available treatments are palliative, focussing on improving the quality of life. At present, available options are surgery, embolization, radiation, chemotherapy, immunotherapy and use of other more targeted drugs. In this review, we describe the cellular and molecular effects of current chemotherapy drugs such as gemcitabine, FOLFIRINOX (5-fluorouracil [5-FU], oxaliplatin, irinotecan, and leucovorin) and ABRAXANE (nab-Paclitaxel), which have shown a survival benefit, although modest, for pancreatic cancer patients...
November 22, 2017: Advances in Biological Regulation
https://www.readbyqxmd.com/read/29207968/palliative-chemotherapy-for-pancreatic-adenocarcinoma-a-retrospective-cohort-analysis-of-efficacy-and-toxicity-of-the-folfirinox-regimen-focusing-on-the-older-patient
#3
Anne Katrin Berger, Georg Martin Haag, Martin Ehmann, Anne Byl, Dirk Jäger, Christoph Springfeld
BACKGROUND: Pancreatic cancer occurs more frequently in older patients, but these are underrepresented in the phase III clinical studies that established the current treatment standards. This leads to uncertainty regarding the treatment of older patients with potentially toxic but active regimens like FOLFIRINOX. METHODS: We conducted a retrospective analysis of patients treated according to the FOLFIRINOX protocol at our institution between 2010 and 2014 with a focus on older patients...
December 6, 2017: BMC Gastroenterology
https://www.readbyqxmd.com/read/29189332/clinical-management-metastatic-disease
#4
Andrew H Ko
Most patients with pancreatic cancer either present with or eventually develop metastatic disease during the course of their illness. For such individuals, systemic therapy, namely, cytotoxic therapy, represents the mainstay of treatment and is administered with noncurative intent. Of the various chemotherapy options now available for treating metastatic pancreatic cancer, 2 combination regimens, FOLFIRINOX (infusional 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) and the doublet of gemcitabine and albumin-bound paclitaxel, have emerged as frontline standards of care, based on phase III studies demonstrating a significant survival benefit compared with single-agent gemcitabine...
November 2017: Cancer Journal
https://www.readbyqxmd.com/read/29162142/-heatpac-a-phase-ii-randomized-study-of-concurrent-thermochemoradiotherapy-versus-chemoradiotherapy-alone-in-locally-advanced-pancreatic-cancer
#5
Niloy Ranjan Datta, Bernhard Pestalozzi, Pierre-Alain Clavien, Alexander Siebenhüner, Emsad Puric, Shaka Khan, Christoph Mamot, Oliver Riesterer, Jürg Knuchel, Cäcilia Sophie Reiner, Stephan Bodis
BACKGROUND: Pancreatic cancer has a dismal prognosis with 5-year overall survival rate of around 5%. Although surgery is still the best option in operable cases, majority of the patients who present in locally advanced stages are deemed inoperable. Novel approaches are therefore needed for the management of around 80% of these inoperable locally advanced pancreatic cancers (LAPC). Hyperthermia (39-43 °C) is a potent radiosensitizer and further enhances the action of gemcitabine, also a known radiosensitizer...
November 21, 2017: Radiation Oncology
https://www.readbyqxmd.com/read/29143916/a-real-world-comparison-of-folfirinox-gemcitabine-plus-nab-paclitaxel-and-gemcitabine-in-advanced-pancreatic-cancers
#6
Ying Wang, Pierre Camateros, Winson Y Cheung
PURPOSE: FOLFIRINOX (FFN), nab-paclitaxel plus gemcitabine (GN), and gemcitabine are three systemic therapies that provide clinically meaningful benefit to patients with unresectable pancreatic cancer (UPC). There are no clinical trials that directly compare the efficacy of all three regimens. In this study, we aim to examine and compare the real-world effectiveness of these treatments. METHODS: Patients diagnosed with UPC who initiated palliative chemotherapy from August 2014 to January 2016 at any one of six cancer centers in British Columbia were identified from the provincial pharmacy...
November 16, 2017: Journal of Gastrointestinal Cancer
https://www.readbyqxmd.com/read/29137884/uptake-and-effectiveness-of-folfirinox-for-advanced-pancreatic-cancer-a-population-based-study
#7
S Karim, J Zhang-Salomans, J J Biagi, T Asmis, C M Booth
AIMS: Although FOLFIRINOX is a standard treatment option for advanced pancreas cancer, there are few data describing utilisation and effectiveness in routine clinical practice. Here we report practice patterns and outcomes in the general population of Ontario, Canada. MATERIALS AND METHODS: Using the Ontario Cancer Registry and New Drug Funding Program, we identified all patients with pancreas cancer treated with palliative intent gemcitabine or FOLFIRINOX in Ontario during 2006-2014...
November 11, 2017: Clinical Oncology: a Journal of the Royal College of Radiologists
https://www.readbyqxmd.com/read/29094028/survival-outcome-and-prognostic-factors-of-neoadjuvant-treatment-followed-by-resection-for-borderline-resectable-pancreatic-cancer
#8
Hyeong Seok Kim, Jin-Young Jang, Youngmin Han, Kyoung Bun Lee, Ijin Joo, Doo-Ho Lee, Jae Ri Kim, Hongbeom Kim, Wooil Kwon, Sun-Whe Kim
Purpose: Neoadjuvant treatment may provide improved survival outcomes for patients with borderline resectable pancreatic cancer (BRPC). The purpose of this study is to evaluate the clinical outcomes of neoadjuvant treatment and to identify prognostic factors. Methods: Forty patients who met the National Comprehensive Cancer Network definition of BRPC and received neoadjuvant treatment followed by surgery between 2007 and 2015 were evaluated. Prospectively collected clinicopathological outcomes were analyzed retrospectively...
October 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28989542/cross-over-comparison-and-new-chemotherapy-regimens-in-metastatic-pancreatic-cancer
#9
REVIEW
Markus Kieler, Matthias Unseld, Daniela Bianconi, Gerald W Prager
Despite decades of research, pancreatic ductal adenocarcinoma (PDAC) is still one of the most lethal malignant diseases with a devastating 5‑year overall survival of only 4-5%. Indeed, long-term survival was not affected by the introduction of new systemic cytotoxic chemotherapies which remain the key cornerstone in the treatment of metastatic PDAC. In the first-line setting, FOLFIRINOX based upon the results of the PRODIGE/ACCORD trial and gemcitabine with albumin-bound paclitaxel (GNP) based upon the MPACT trial have both been approved as therapeutic options for patients with no significant comorbidities and good performance status...
2017: Memo
https://www.readbyqxmd.com/read/28982109/retrospective-analysis-of-ca19-9-decrease-in-patients-with-metastatic-pancreatic-carcinoma-treated-with-folfirinox-or-gemcitabine-in-a-randomized-phase-iii-study-accord11-prodige4
#10
Marie Robert, Marta Jarlier, Sophie Gourgou, Françoise Desseigne, Marc Ychou, Olivier Bouché, Beata Juzyna, Thierry Conroy, Jaafar Bennouna
OBJECTIVES: Carbohydrate antigen 19-9 (CA19-9) is a sensitive and specific serum marker in pancreatic cancer. Our retrospective analysis aims to evaluate CA19-9 decrease in patients with metastatic pancreatic cancer treated in ACCORD11/PRODIGE4 (FOLFIRINOX vs. gemcitabine). METHODS: A total of 342 patients were treated. CA19-9 was measured at 8 weeks (±2) in 160 patients from a total of 282 with abnormal CA19-9 values at baseline (gemcitabine arm, n = 75; FOLFIRINOX arm, n = 85)...
October 6, 2017: Oncology
https://www.readbyqxmd.com/read/28968257/clinical-characteristics-of-patients-experiencing-pathologic-complete-response-following-neoadjuvant-therapy-for-borderline-resectable-locally-advanced-pancreatic-adenocarcinoma
#11
Neda Hashemi-Sadraei, Olumide B Gbolahan, Hai Salfity, Bert O'Neil, Michael G House, Safi Shahda
OBJECTIVES: The purpose of this study is to describe clinical characteristics and outcomes of patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who achieved pathologic complete response (pCR) following neoadjuvant therapy. MATERIALS AND METHODS: A single institution clinical database for patients with pancreatic ductal adenocarcinoma was queried. Between 2008 and 2014 patients were identified with BRPC and LAPC, who underwent surgical resection after receiving neoadjuvant treatment...
September 29, 2017: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28931010/response-to-folfirinox-by-gender-in-patients-with-metastatic-pancreatic-cancer-results-from-the-prodige-4-accord-11-randomized-trial
#12
RANDOMIZED CONTROLLED TRIAL
Aurélien Lambert, Marta Jarlier, Sophie Gourgou Bourgade, Thierry Conroy
BACKGROUND: Hohla et al. suggested that female gender could positively predict response to FOLFIRINOX in patients with advanced pancreatic cancer. In this study, we explored the response to the FOLFIRINOX regimen by gender within the trial PRODIGE4/ACCORD 11. PATIENTS AND METHODS: Data were described by gender, both in FOLFIRINOX group and in the intention-to-treat population of the trial. The relative effect of gender (females in comparison to males) on overall survival (OS) and progression-free survival was estimated by using a Cox proportional hazard model and was presented with the Hazard Ratio and their 95% confidence interval...
2017: PloS One
https://www.readbyqxmd.com/read/28926090/efficacy-of-different-chemotherapy-regimens-in-treatment-of-advanced-or-metastatic-pancreatic-cancer-a-network-meta-analysis
#13
Shu-Hua Zhang, Gui-Feng Liu, Xue-Feng Li, Lin Liu, Shao-Nan Yu
We performed a network meta-analysis (NMA) to compare the short- and long-term efficacy of Gemcitabine, Gemcitabine + S-1 (tegafur), Gemcitabine + nab-paclitaxel, Gemcitabine + Capecitabine, Gemcitabine + Cisplatin, FOLFIRINOX (oxaliplatin + irinotecan + fluorouracil + leucovorin), Gemcitabine + oxaliplatin, Gemcitabine + irinotecan, Gemcitabine + Exatecan, Gemcitabine + pemetrexed, Gemcitabine + 5-FU and S-1 in treating advanced or metastatic pancreatic cancer (PC)...
September 19, 2017: Journal of Cellular Physiology
https://www.readbyqxmd.com/read/28895032/resection-of-locally-advanced-pancreatic-cancer-without-regression-of-arterial-encasement-after-modern-era-neoadjuvant-therapy
#14
Michael D Kluger, M Farzan Rashid, Vilma L Rosario, Beth A Schrope, Jonathan A Steinman, Elizabeth M Hecht, John A Chabot
INTRODUCTION: Modern-era systemic therapy for locally advanced pancreatic adenocarcinoma (LAPC) offers improved survival relative to historical regimens but not necessarily improved radiographic downstaging to allow more patients to undergo resection. The aim of this study was to evaluate the survival, progression, and pathologic outcomes after resection of LAPC that did not regress from > 180 degrees arterial encasement after neoadjuvant therapy. METHODS: Sixty-one LAPC patients were brought to the operating room after neoadjuvant therapy for NCCN-defined unresectable pancreatic cancer between 2012 and 2017...
September 11, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28890819/the-role-of-induction-chemotherapy-chemoradiotherapy-in-localised-pancreatic-cancer-initial-experience-in-scotland
#15
Derek Grose, David McIntosh, Nigel Jamieson, Ross Carter, Euan Dickson, David Chang, Husam Marashi, Christina Wilson, Mohammed Alfayez, Ashleigh Kerr, Roisin O'Donoghue, Lea Haskins, Fraser Duthie, Colin J McKay, Janet Graham
BACKGROUND: Despite being relatively rare pancreatic cancer is one of the highest causes of death. Even within the potentially resectable group outcomes are poor. We present our initial experiences utilising a neoadjuvant approach to localised pancreatic cancer, evaluating survival, response rates and tolerability. METHODS: This was a retrospective analysis of a prospectively maintained database. Patients from 2012 to 2015 referred to a busy regional Hepato-Pancreatic Biliary (HPB) MDT were included...
August 2017: Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/28888554/how-to-treat-pancreatic-adenocarcinoma-in-elderly-how-far-can-we-go-in-2017
#16
REVIEW
Marine Gilabert, Jean Luc Raoul, Frederique Rousseau
Pancreatic adenocarcinoma is one of the most fatal cancers that frequently affects older patients. Limited data suggest that older patients are as likely to benefit from surgery, radiation, and chemotherapy as younger patients. The only potentially curative approach for pancreatic cancer is surgery but this is only performed in less than 20% of patients considered resectable. With improvements in surgical techniques, older patients without major comorbidities show a course of disease after resection similar to that of younger patients...
November 2017: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/28869888/pancreatic-ductal-adenocarcinoma-state-of-the-art-2017-and-new-therapeutic-strategies
#17
REVIEW
Marta Chiaravalli, Michele Reni, Eileen M O'Reilly
Pancreatic ductal adenocarcinoma (PDAC) is a fatal malignancy with an overall 5-year survival of 8% for all stages combined. The majority of patients present with stage IV disease at diagnosis and these patients have an overall 5-year survival of 3%. Currently, the standard of care for metastatic pancreas adenocarcinoma is combination cytotoxic therapy, namely FOLFIRINOX or gemcitabine plus nab-paclitaxel for good performance status patients. Given the challenges and the rising incidence of PDAC expected to become the second leading cause of cancer-related death by 2030, there is a major unmet need to develop more effective therapies...
November 2017: Cancer Treatment Reviews
https://www.readbyqxmd.com/read/28864067/a-novel-chemoradiation-targeting-stem-and-nonstem-pancreatic-cancer-cells-by-repurposing-disulfiram
#18
Juan Cong, Yangyang Wang, Xiao Zhang, Nan Zhang, Ling Liu, Klara Soukup, Theodoros Michelakos, Theodore Hong, Albert DeLeo, Lei Cai, Francesco Sabbatino, Soldano Ferrone, Hang Lee, Vera Levina, Bryan Fuchs, Kenneth Tanabe, Keith Lillemoe, Cristina Ferrone, Xinhui Wang
Pancreatic ductal adenocarcinoma (PDAC) has a 5-year relative survival rate of 8% and is projected to be the second leading cause of cancer death by 2030, underscoring the urgency to develop new strategies to improve current therapeutic modalities for PDAC. Targeting pancreatic cancer stem cells (PCSCs), which are resistant to radiation and chemotherapy, is a promising strategy. A novel approach which can be readily clinically translated is to repurpose disulfiram (DSF), a drug for treating alcoholism, to target PCSCs...
November 28, 2017: Cancer Letters
https://www.readbyqxmd.com/read/28841916/neoadjuvant-chemotherapy-versus-surgery-first-for-resectable-pancreatic-cancer-norwegian-pancreatic-cancer-trial-1-norpact-1-study-protocol-for-a-national-multicentre-randomized-controlled-trial
#19
Knut Jørgen Labori, Kristoffer Lassen, Dag Hoem, Jon Erik Grønbech, Jon Arne Søreide, Kim Mortensen, Rune Smaaland, Halfdan Sorbye, Caroline Verbeke, Svein Dueland
BACKGROUND: Pancreatic cancer is the fourth leading cause of cancer-related death. While surgical resection remains the foundation for potentially curative treatment, survival benefit is achieved with adjuvant oncological treatment. Thus, completion of multimodality treatment (surgical resection and (neo)adjuvant chemotherapy) to all patients and early treatment of micrometastatic disease is the ideal goal. NorPACT-1 aims to test the hypothesis that overall mortality at one year after allocation of treatment can be reduced with neoadjuvant chemotherapy in surgically treated patients with resectable pancreatic cancer...
August 25, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28835777/current-status-on-the-place-of-folfirinox-in-metastatic-pancreatic-cancer-and-future-directions
#20
REVIEW
Aurélien Lambert, Céline Gavoille, Thierry Conroy
Pancreatic cancer (PC) incidence rates are rapidly increasing in developed countries, with half the patients being metastatic at diagnosis. For decades, fluorouracil, then gemcitabine regimens were the preferred palliative first-line options for fit patients with metastatic PC. FOLFIRINOX (a combination of bolus and infusional fluorouracil, leucovorin, irinotecan and oxaliplatin) was introduced to clinical practice in 2010 due to the results of the phase II/III trial (PRODIGE 4/ACCORD 11) comparing FOLFIRINOX with single-agent gemcitabine as first-line treatment for patients with MPC...
August 2017: Therapeutic Advances in Gastroenterology
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