Second line Folfox for pancreatic cancer – pro

In patients treated with the standard palliative treatment gemcitabine (GEM), median survival still remains only 6 months. Over the last several years, many trials have been designed combining GEM with various other drugs to treat chemo-naive patients, with the aim to improve overall survival. Unfortunately, none of the GEM-based combinations studied so far have reached that objective, with the exception of GEM plus Erlotinib, which showed a slight increase in OS to 6.4 months. However, some trials – mainly those using platinum based combinations – have shown an increase in response rate and time to progression.However, there are still no guidelines or recommendations for selecting treatment for patients progressing after GEM therapy; nor are there any reports of regimens with demonstrated activity that would enable one to justify one approach over another.
Folfox is an appropriate second line regimen in this situation. There is a trial: Randomized Phase II Study of FOLFOX Versus FOLFIRI.3 in Gemcitabine-Refractory Pancreatic Cancer, NCT00786006. The trial shows that Folfox is the default, if not the standard option in this situation. The investigators were to evaluate the efficacy and safety of FOLFOX or FOLFIRI combination chemotherapy as second-line salvage chemotherapy in patients with advanced pancreatic carcinoma. The results were just published in abstract form. Both FOLFOX and FOLFIRI were tolerated with manageable toxicity, offering modest activity as second-line treatment of patients with advanced or metastatic pancreatic cancer, previously treated with gemcitabine. NCCN lists Folfox as well.

H. Q. Xiong, R. A. Wolff, K. R. Hess, G. R. Varadhachary, J. C. Blais and J. L. Abbruzzese A phase II trial of oxaliplatin plus capecitabine (xelox) as second line therapy for patients with advanced pancreatic cancer Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings (Post-Meeting Edition).

Vol 24, No 18S (June 20 Supplement), 2006: 4119
FOLFOX-6 Combination in the First-Line Treatment of Locally Advanced and/or Metastatic Pancreatic Cancer. ASCO 2006, Abstract 106]

W, Nasr F, Chahine G.FOLFOX-6 combination as the first-line treatment of locally advanced and/or metastatic pancreatic Am J Clin Oncol. 2007 Feb;30(1):15-20. Ghosn M, Farhat F, Kattan J, Younes F, Moukadem

Hwang, J. Y., Yoo, C., Kim, T., Lee, J., Park, D., Seo, D., Lee, S., Kim, M., Han, D., Kim, S., Lee, J.
A randomized phase II study of FOLFOX or FOLFIRI.3 as second-line therapy in patients with advanced pancreatic cancer previously treated with gemcitabine-based chemotherapy
J Clin Oncol (Meeting Abstracts) 2009 27: 4618

Zaanan A, Trouilloud I, Markoutsaki T, Gauthier M, Dupont-Gossart AC, Lecomte T, Aparicio T, Artru P, Thirot-Bidault A, Joubert F, Fanica D, Taieb JFOLFOX as second-line chemotherapy in patients with pretreated metastatic pancreatic cancer from the FIRGEM study.BMC Cancer. 2014 Jun 14;14:441.

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