ASCO: adjuvant mFOLFIRINOX preferred for pancreatic cancer

  • Khorana AA & al.
  • J Clin Oncol
  • 10 Jun 2019

  • Oncology guidelines update
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Takeaway

  • An update to the American Society for Clinical Oncology’s guidelines on potentially curable pancreatic adenocarcinoma includes practice-changing data on adjuvant chemotherapy.

Why this matters

  • The update incorporates data from the PRODIGE 24/CCTG PA.6 trial, which was presented at ASCO in 2018.

Key points

  • Patients with resected pancreatic adenocarcinoma who did not undergo neoadjuvant therapy should be considered for a 6-month regimen of adjuvant chemotherapy, barring surgical or medical contraindications.
  • PRODIGE 24/CCTG PA.6 (N=493) showed an OS advantage (HR, 0.66; 95% CI, 0.49-0.89) for a modified combination regimen of 5-fluorouracil, oxaliplatin, and irinotecan (mFOLFIRINOX) vs gemcitabine.
  • Assuming no concerns over toxicity or tolerance, the preferred regimen is mFOLFIRINOX: oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 150 mg/m2 D1, and 5-FU 2.4 g/m2 over 46 hours every 14 days for 12 cycles.
  • Alternative therapies are gemcitabine plus capecitabine, gemcitabine alone, or fluorouracil plus folinic acid alone.
  • The strength of evidence for these recommendations is strong, with high evidence quality.