FOLFIRINOX in the real world setting: The multicentric experience of six Canadian institutions.
Bibliographic record
Abstract
e15232 Background: FOLFIRINOX is a new standard for patients with metastatic pancreatic cancer with good performance status. Non-randomized studies also support this regimen in locally advanced disease. This regimen is however associated with significant toxicity. The purpose of this study was to assess efficacy and toxicity outside of a clinical trial, including community hospitals. Methods: We conducted a retrospective study of patients with pancreatic adenocarcinoma who received FOLFIRINOX between January 2011 and December 2013 in six institutions in the province of Quebec, Canada. Patients' characteristics, objective response, survival and toxicities were collected from chart review. Results: Fifty-five patients were included (30 metastatic and 25 locally advanced). Median age was 59 years. Tumor was localized at the head of pancreas in 65% of patients and 44% had a biliary stent. 85% of patients received full doses at the first cycle. Median overall survival was 14,0 months and survival at one year was 65% for metastatic patients. For locally advanced patients, median overall survival was 21,5 months and survival at one year was 89%. No one with locally advanced tumor became candidate for curative surgery after FOLFIRINOX. Hospitalization rate was 64% with sepsis being the leading cause. There were three treatment-related deaths (5%). One of them was ECOG 2 and two of them occurred after the first cycle. Neutropenia grade ≥ 3 was observed in 31% of patients and four had febrile neutropenia (7%) with 64% of patients receiving colony-stimulating factors (CSFs) for primary prophylaxis. Six patients had cholangitis (11%) and 18% had diarrhea grade ≥ 3. Conclusions: Survival for patients with metastatic pancreatic cancer in our cohort is comparable with data reported by Conroy et al. The good outcome for the subgroup of patients with locally advanced pancreatic tumors also supports the use of this regimen in this population. It was however associated with a high hospitalization rate and treatment-related deaths. Our population had a higher proportion of pancreatic head tumors and could partly explain higher toxicities. These data highlight the importance of patient selection and support the universal use of G-CSF.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".