Sequential Use of AG and mFOLFIRINOX as Neoadjuvant Chemotherapy for Resectable Pancreatic Cancer
The prognosis of pancreatic cancer is extremely poor. Current guidelines recommend Nab-paclitaxel, Gemcitabine and modified Folfirinox as the first-line chemotherapeutic regimen. Studies have shown that sequential chemotherapeutic regimen can effectively delay the drug resistance and improve the effect of chemotherapy. Here investigators intend to assess the effect of sequential treatment with Nab-paclitaxel plus Gemcitabine and modified Folfirinox as neoadjuvant chemotherapy for resectable pancreatic adenocarcinoma.
|Condition or Disease||Intervention/Treatment||Phase|
Investigators chose resectable pancreatic adenocarcinoma patients. The planned treatment was given to the participants after randomization. Tumor size, recurrence-free survival, overall survival, drugs related side effects and other endpoints events were recorded and analyzed, to assess the sequential treatment with Nab-paclitaxel plus Gemcitabine and modified Folfirinox could or couldn't benefit the prognosis of resectable pancreatic adenocarcinoma.
Arms and Interventions
|Experimental: Neoadjuvant Chemotherapy
Patients receive the sequential neoadjuvant chemotherapy of AG regimen (nab-paclitaxel plus gemcitabine) and mFOLFIRINOX before resection.
Drug: AG regimen
Combination of Nab-paclitaxel 125 mg/m^2 and Gemcitabine 1000 mg/m^2
Folic acid 400mg/m^2, 5- fluorouracil 2400mg/m^2 for 46h, irinotecan 135mg/m^2 and oxaliplatin 68mg/m^2
|No Intervention: control
Patients receive surgical treatment without any neoadjuvant treatments.
Primary Outcome Measures
- Disease-free survival [Up to approximately 60 months]
The time of initial response until documented tumor recurrence.
Secondary Outcome Measures
- Overall survival [Up to approximately 60 months]
The time of initial response until documented patient death
- Objective response rate [Up to approximately 60 months]
The proportion of patients with tumor size reduction of a predefined amount and for a minimum time period
- Carbohydrate antigen 19-9 [Up to approximately 60 months]
Serum Carbohydrate antigen 19-9 level
- EORTC QLQ - PAN26 score [Up to approximately 60 months]
QLQ score assessed by the European Organization for Research and Treatment of Cancer Quality of Life scale for pancreatic cancer (EORTC QLQ - PAN26. For details: PMID 10533475.)
- Serious adverse events incidence [Up to approximately 60 months]
The proportion of patients with grade 3/4 adverse events
Pathologically (histologically or cytologically) confirmed pancreatic ductal adenocarcinoma (PDAC).
No evidence of distant metastasis (such as liver, peritoneum, lung) evaluated by abdominal contrast-enhanced CT, MRI, and chest CT. PET/CT or other imaging examinations would be used if necessary.
Initial assessment for definitive resectable tumors (resectability judgment is based on CT enhanced scan or magnetic resonance imaging, NCCN2018 first edition standard).
ECOG score 0 or 1.
Serum creatinine level is normal, and serum total bilirubin level is less than 1.5 x ULN.
ALT and AST are less than 2 x ULN.
If biliary obstruction is observed, biliary decompression should be performed when the patient is randomly assigned to receive neoadjuvant chemotherapy.
Leukocyte count (> 3.5 x 106 /mL), neutrophil count (> 1.5 x 106 /mL), platelet count (> 80 x 10^6 /mL), hemoglobin (> 9 g/dL).
Signed informed consent.
History of malignance treatment in the past, excluding basal and cutaneous squamous cell carcinoma, cervical carcinoma in situ, papillary thyroid carcinoma
Tumor is a local recurrent lesion.
Imaging confirmed severe portal hypertension / cavernous transformation.
Gastric outlet obstruction
Respiratory failure requires supplementation of oxygen.
Immune deficiency syndrome, such as active tuberculosis and HIV infection.
Hematological precancerous diseases, such as myelodysplastic syndromes.
Major cardiovascular diseases (including myocardial infarction, unstable angina, congestive heart failure, severe uncontrolled arrhythmia) during the past six months of enrollment.
Evidence of clinical-related or previous interstitial lung disease, such as noninfectious pneumonia or pulmonary fibrosis, or baseline chest CT scan or chest X-ray findings
Previous or physical findings of central nervous system disease, except for adequately treated (e.g. primary brain tumors, uncontrolled seizures or strokes with standard medications)
Preexisting neuropathy > 1 (NCI CTCAE).
Allograft requires immunosuppressive therapy or other major immunosuppressive therapies.
Severe serious wounds, ulcers or fractures.
Confirmed coagulant disease.
Clinical evaluation is unacceptable.
Contacts and Locations
|1||The second affiliated hospital of Zhejiang University||Hangzhou||Zhejiang||China|
Sponsors and Collaborators
- Second Affiliated Hospital, School of Medicine, Zhejiang University
- Principal Investigator: Tingbo Liang, MD PhD, Department of HBP Surgery, SAHZJU
Study Documents (Full-Text)None provided.