Low-Dose Continuous 5-Fluorouracil Combined with Leucovorin, nab-Paclitaxel, Oxaliplatin, and Bevacizumab for Patients with Advanced Pancreatic Cancer: A Retrospective Analysis

Autor: William Arthur Hoos, Lola Rahib, Timothy R. Donahue, O. Joe Hines, Alexander Upfill-Brown, Rudolph A. Bedford, Howard A. Reber, William H. Isacoff
Rok vydání: 2018
Předmět:
0301 basic medicine
Male
Cancer Research
medicine.medical_treatment
Leucovorin
Gastroenterology
0302 clinical medicine
Antineoplastic Combined Chemotherapy Protocols
80 and over
Pharmacology (medical)
Original Research Article
Cancer
Aged
80 and over
Middle Aged
Bevacizumab
Oxaliplatin
Oncology
Fluorouracil
6.1 Pharmaceuticals
030220 oncology & carcinogenesis
Female
Drug
medicine.drug
Adult
medicine.medical_specialty
Paclitaxel
Clinical Trials and Supportive Activities
Oncology and Carcinogenesis
and over
Dose-Response Relationship
Pancreatic Cancer
03 medical and health sciences
Rare Diseases
Breast cancer
Clinical Research
Internal medicine
Pancreatic cancer
medicine
Humans
Oncology & Carcinogenesis
Retrospective Studies
Aged
Leucovorin Calcium
Chemotherapy
Dose-Response Relationship
Drug
business.industry
Evaluation of treatments and therapeutic interventions
medicine.disease
Survival Analysis
Pancreatic Neoplasms
Regimen
030104 developmental biology
Digestive Diseases
business
Zdroj: Targeted oncology, vol 13, iss 4
Targeted Oncology
Popis: BackgroundContinuous-infusion 5-fluorouracil (5FU) and calcium leucovorin plus nab-paclitaxel and oxaliplatin have been shown to be active in patients with pancreatic cancer. As a protracted low-dose infusion, 5FU is antiangiogenic, and has synergy with bevacizumab. As shown in the treatment of breast cancer, bevacizumab and nab-paclitaxel are also synergetic.ObjectiveIn this paper we retrospectively analyze the survival of 65 patients with advanced pancreatic cancer who were treated with low-dose continuous (metronomic) chemotherapy given in conjunction with conventional anti-VEGF therapy.Patients and methodsSince July of 2008, we have treated 65 patients with 5FU (180mg/m2/day × 14days) via an ambulatory pump. Calcium leucovorin (20mg/m2 IV), nab-paclitaxel (60mg/m2) IV as a 30-min infusion, and oxaliplatin (50mg/m2) IV as a 60-min infusion were given on days 1, 8, and 15. Bevacizumab (5mg/kg) IV over 30min was administered on days 1 and 15. Cycles were repeated every 28-35days. There were 42 women and 23 men, and the median age was 59 years. Forty-six patients had stage IV disease.ResultsThe median survival was 19months, with 82% of patients surviving 12months or longer. The overall response rate was 49%. There were 28 patients who had received prior treatment, 15 of whom responded to therapy. Fifty-two patients had elevated CA 19-9 prior to treatment. Of these, 21 patients had 90% or greater reduction in CA 19-9 levels. This cohort had an objective response rate of 71% and a median survival of 27months. Thirty patients stopped treatment due to disease progression, and an additional 22 stopped because of toxicity. One patient died while on therapy.ConclusionsThis non-gemcitabine-based regimen resulted in higher response rates and better survival than what is commonly observed with therapy given at conventional dosing schedules. Low-dose continuous (metronomic therapy) cytotoxic chemotherapy combined with antiangiogenic therapy is safe and effective.
Databáze: OpenAIRE
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