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A retrospective comparative study of S-IROX and modified FOLFIRINOX for patients with advanced pancreatic cancer refractory to gemcitabine plus nab-paclitaxel

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Purpose: The aim of this study was to evaluate the efficacy and tolerability of S-IROX and modified FOLFIRINOX (mFFX) after gemcitabine plus nab-paclitaxel for advanced pancreatic cancer (PC) in the real world setting. Methods: Consecutive patients receiving S-IROX or mFFX as a second-line chemotherapy for advanced PC refractory to gemcitabine plus nab-paclitaxel were retrospectively studied. Patients were treated every 2 weeks: S-1 40 mg/m2 was administered orally twice daily on days 1 to 7 in S-IROX and 5-fluorouracil 2400 mg/m2 was intravenously administered for 46 h without bolus infusion in mFFX, in addition to intravenous oxaliplatin 85 mg/m2 and irinotecan 150 mg/m2 on day 1 in both regimens. Results: Fifty-four patients with advanced PC who received S-IROX (n = 19) or mFFX (n = 35) were retrospectively studied. The disease control rate and response rate were 73.7% and 10.5% in the S-IROX group and 62.2% and 2.7% in the mFFX group, respectively. The median progression free survival (PFS) was 7.8 and 5.7 months in the S-IROX and mFFX groups (p = 0.24). The median overall survival (OS) was 14.2 and 11.5 months in the S-IROX and mFFX groups (p = 0.34). There were no significant differences in the incidences of grade 3–4 adverse effects. The subgroup analyses suggested S-IROX demonstrated favorable OS in patients with PFS ≥6 months of first-line gemcitabine plus nab-paclitaxel (p for interaction = 0.02). Conclusions: S-IROX and mFFX were similarly tolerable and effective as a second-line chemotherapy in patients with PC refractory to gemcitabine plus nab-paclitaxel.

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This study has never been funded by any foundation, company, industry, or other external source.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan

    Kei Saito, Yousuke Nakai, Naminatsu Takahara, Kazunaga Ishigaki, Yukari Suzuki, Akiyuki Inokuma, Kensaku Noguchi, Sachiko Kanai, Tatsuya Sato, Ryunosuke Hakuta, Tomotaka Saito, Tsuyoshi Hamada, Suguru Mizuno, Hirofumi Kogure, Hideaki Ijichi, Keisuke Tateishi & Kazuhiko Koike

  2. Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan

    Yousuke Nakai & Ryunosuke Hakuta

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  1. Kei Saito
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Correspondence to Yousuke Nakai.

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Yousuke Nakai received research funding from Taiho Pharmaceutical Co and Yakult Honsha Co. All remaining authors declare that they have no conflict of interest.

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Saito, K., Nakai, Y., Takahara, N. et al. A retrospective comparative study of S-IROX and modified FOLFIRINOX for patients with advanced pancreatic cancer refractory to gemcitabine plus nab-paclitaxel. Invest New Drugs 39, 605–613 (2021). https://doi.org/10.1007/s10637-020-01022-0

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