FOLFIRINOX in Advanced Pancreatic Cancer: A Single-Center Experience
Bibliographic record
Abstract
Introduction: Since 2010, FOLFIRINOX has become a standard treatment for advanced pancreatic adenocarcinoma but some concerns remain about the safety profile of this chemotherapy combination. This study reviews our local experience with FOLFIRINOX. Methods: All patients treated with FOLFIRINOX for advanced pancreatic cancer in our center between 2010 and 2015 were identified. Anthropometric informations, chemotherapy, dose modifications, toxicities and overall outcomes were retrospectively analyzed. Overall survival (OS) and progression-free survival (PFS) were estimated with Kaplan-Meier curves. Results: 39 patients were included, 20 with locally advanced (LA) and 19 with metastatic cancer (M+). Patients' mean age was 58 years (67% male). The performance status (ECOG) before chemotherapy were 0 (51%), 1 (46%) and 2 (3%). 5 patients (13%) had surgery before chemotherapy (80% Whipple) and 3 had Gemcitabine. At the first cycle of FOLFIRINOX, the 5-FU bolus was omitted in 34 (87%) and the dose of Irinotecan reduced in 15 (38.5%). The median number of cycles of chemotherapy was 6, with 8 patients (20.5%) completing 12 cycles and 21 patients (53.9%) having less than 6. Thus, FOLFIRINOX was stopped in 31 (79.5%), because of progression (54.8%), toxicities (25.8%), radiotherapy (6.5%) or patient's choice (12.9%). Also, 29 of them had dose modification, the most common reason being doctor's decision (24.1%), vomiting (20.7%), neutropenia (17.2%), fatigue (13.8%) and neuropathy (10.3%). 100% of patients received G-CSF. 23 severe adverse events (grade ≥3) occurred (12.8% neutropenia, 7.7% neuropathy, 20.5% fatigue, 15.4 % vomiting and 2.6% diarrhea). During the course of their illness, 30.7% of patients suffered from thromboembolic disease, 17.9% had cholangitis and 71.8% were hospitalised (mostly because of infections (28.2%) and pain (17.9%)). Complete response was seen in 3 (7.7%), partial response in 8 (20.5%), stable disease in 15 (38.4%) and progressive disease in 13 (33.3%) of our patients. The median OS was 7.0 months (6.3-7.5) for the M+ group and 15.3 months (9.9-20.6) for the LA group. The median PFS was 3.1 months for the M+ and 7.1 for the LA patients. In the latter group, the survival at one year was 75.9%. Conclusion: Our local experience shows comparable survival results for LA group while lower than expected for the M+ group. Toxicities were similar to previous studies. Further research is needed to assess the impact of dose modification on survival.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".