Pancreatic Cancer Progress? or Static Flux? (Folfirinox)

Static flux is a phenomenon during which things seem to be changing but in reality are not.

Pancreatic cancer sadly has been in this state since the advent of the chemotherapy age in the 70’s. Drugs are touted with great hoopla (gemcitabine, erlotinib and others) but patients still seem to have a live expectancy of less than one year. So it was with some trepidation that I looked at news of the latest “advance” (Folfirinox a combination of 5FU, leukovorin, irinotecan and oxalplatin)

For the first time in years, doctors are making progress against pancreatic cancer, one of the deadliest of all tumors, which kills all but 6% of patients.

Patients taking Folfirinox, a novel combination of four drugs already approved to fight other cancers, lived 11.1 months — 4.3 months longer than those given standard chemo, according to a French study of 342 patients in today’s New England Journal of Medicine.

and:

A chemotherapy combination has been shown to provide the best survival time ever reported in metastatic pancreatic cancer, according to a study from French researchers.

But:

However, the combination of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) was considerably more toxic than gemcitabine in the phase 3 trial.


Survival curves from the NEJM article.

Toxicity included serious life threatening side effects in more than 5% of patients, elevated liver function tests, loss of hair, severe diarrhea, nerve damage, fatigue, and drops in all the blood counts causing anemia, risk of bleeding and infection.

Medicynical Note: Patients with metastatic pancreatic cancer, except in very rare instances, are not “cured” of their disease. In this study the median progression free survival with treatment was 6.4 months compared with 3.3 months and overall survival 11.1 versus 6.8 months in the gemcitabine group.

Even with this new finding the unenviable choice of people with pancreatic cancer is between an earlier demise by a few months or to live a little longer but with significantly more toxicity from treatment.

While an advance this treatment does not provide an order of magnitude improvement. Hopefully the results will be confirmed.




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