It is is appropriate and necessary for the symptoms, diagnosis or direct care and treatment of the medical condition,
injury or illness;
Provided for the diagnosis or direct care and treatment of the medical condition, injury or illness;
Within standards of good medical practice within the organized medical community; Not primarily for the convenience of the covered person, the covered person’s physician or another provider;
and The most appropriate supply or level of service which can safely be provided.
Currently gemcitabine or gemcitabine with erlotinib are FDA approved for pancreatic cancer4 . First-line treatment with the FOLFIRINOX regimen for metastatic pancreatic adenocarcinoma in patients with a good performance status significantly improved OS, PFS1
Combination chemotherapy is the new frontier for metastatic pancratic cancer. A major recent advance has been the combination of irinotecan, florouracyl and oxaliplatin response rate and time to degradation of quality of life compared with gemcitabine, according to the phase 3 results of the PRODIGE 4/ACCORD 11 trial. Of concern, however, is the tolerability and toxicity of this elaborate multidrug regimen. However, NCCN has now included Fofirinox in its recommendations (2011, PANC-E) as a level 1 recommendation4. It is also recommended by ESMO for patients younger than age 75 3.
1.ASCO 2010, [Presentation title: Randomized Phase III Trial Comparing FOLFIRINOX (5FU/ Leucovorin, Irinotecan and Oxaliplatin) vs Gemcitabine as First-Line Treatment for Metastatic Pancreatic Adenocarcinoma. Prodige 4 - ACCORD 11/0402 Trial: Final Results. Late-Breaking Presentation]
2.Thierry Conroy, M.D., Françoise Desseigne, M.D., Marc Ychou, M.D., Ph.D., Olivier Bouché, M.D., Ph.D., Rosine Guimbaud, M.D., Ph.D., Yves Bécouarn, M.D., Antoine Adenis, M.D., Ph.D., Jean-Luc Raoul, M.D., Ph.D., Sophie Gourgou-Bourgade, M.Sc., Christelle de la Fouchardière, M.D., Jaafar Bennouna, M.D., Ph.D., Jean-Baptiste Bachet, M.D., Faiza Khemissa-Akouz, M.D., Denis Péré-Vergé, M.D., Catherine Delbaldo, M.D., Eric Assenat, M.D., Ph.D., Bruno Chauffert, M.D., Ph.D., Pierre Michel, M.D., Ph.D., Christine Montoto-Grillot, M.Chem., and Michel Ducreux, M.D., Ph.D. for the Groupe Tumeurs Digestives of Unicancer and the PRODIGE Intergroup, FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer,” May 12, i2011 New England Journal of Medicine.
3.T. Seufferlein et al, Pancreatic adenocarcinoma: ESMOESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. nn Oncol (2012) 23 (suppl 7):vii33-vii40.
4.NCCN, Pancreatic Cancer 2015