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ASCO Webinar Summary: Pancreatic Cancer-II

Pharmacokinetically-guided 5-FU dose optimization within the preoperative folfoxiri regimen in resectable pancreatic cancer patients

 (Link to full article)

 Author, Company : Anna Vilalta, University of Navarra, Pamplona, Spain and others

Abstract Number: 4636

Indications : resectable pancreatic cancer (PC)

Interventions : 5-FU, folfoxiri

Background and objectives:

Patients having resectable PC are mostly treated with neoadjuvant therapy. The objective of study was to determine whether 5-FU PK parameters had any correlation with outcomes in resectable PC patients treated with preoperative folfoxiri.

Results from November 2012 to October 2018 for 29 resectable PC patients with preoperative folfoxiri and 5-FU treatment were retrospectively assessed. 5-FU concentrations were analyzed by HPLC in two plasma samples during the infusions in at least two cycles.

Results and observations:

Log-Rank test was performed in this exploratory analysis to examine PFS based on

5-FU AUC values. 29 patients had an R0 resection rate of 90% in the intention-to-treat analysis.

  • Grade 3-4 induction polychemotherapy (IPCT) related toxicities and grade 3 (chemoradiation) CRT related toxicities were reported in 40% and 30% of patients, respectively
  • Median PFS was 723 days (24 months) and median 5-FU AUC 28.5 mcg*h/ml (23-53)
5-FU AUC Median PFS
≥27mcg*h/ml 29 months
<27 mcg*h/ml 15 months

(Adjusted hazard ratio for disease progression 0.223)

Conclusion:

Longer PFS was observed in patients whose 5-FU PK AUC is ≥ 27mcg*h/ml compared to those whose AUC < 27mcg*h/ml

Key take-away:

PK parameter of 5-FU optimizes the folfoxiri regimen by significantly increasing the PFS in resectable PC patients.

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