Patients with pancreatic cancer who take a combination of four chemotherapy medications were found to have 60% better average survival, French scientists reported in NEJM (New England Journal of Medicine). Despite having to endure several side effects, the scientists informed that the quality of life of the survivors was not badly affected.

Pancreatic cancer has an extremely high death rate. For this reason, patients are more likely to willingly endure chemotherapy side effects in order to live a few months longer.

Of the approximately 43,000 people who are diagnosed with pancreatic cancer in the USA annually, 36,800 of them die from it. Pancreatic cancer represents only 2.5% of all cancer cases in America, but is the fourth leading cause of cancer death in the country. Fewer than 6% of patients survive for longer than five years after diagnosis.

Dr. Thierry Conroy of Nancy University and Centre Alexis Vautrin, Nancy, France, performed a Phase III trial - known as PRODIGE 4/ACCORD 11 - on 342 patients with pancreatic cancer. Half of them were randomly selected to receive FOLFIRINOX (made up of four drugs: oxaliplatin, irinotecan, leucovorin and fluorouracil), while the other half received Gemzar (gemcitabine), the first line drug used for pancreatic cancer therapy. They were all under seventy-six years of age and received their medications for six months.

The median survival time was:
  • 6.8 months in the gemcitabine group. After six months 66% reported a significant decline in their quality of life.
  • 11.1 months in the FOLFIRINOX group. After six months 31% reported a considerable decline in their quality of life.
Those in the FOLFIRINOX group experienced significantly more side effects, including diarrhea, weight loss, numbness in hands and feet, and pain. However, the patients felt the side effects were worth it and did not severely undermine their quality of life.

The researchers said that FOLFIRINOX therapy should only be used for patients aged less than 75 years, due to its high toxicity.

They wrote:

(FOLFIRINOX is now a first line option for metastatic pancreatic patients) who are younger than 76 years, and who have a good performance status ([Eastern Cooperative Oncology Group score (ECOG)] 0 or 1), no cardiac ischemia and normal or nearly normal bilirubin levels."

This study was financed by pharmaceutical company Amgen, the French government, and the French National League Against Cancer.

"FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer"
Thierry Conroy, M.D., Françoise Desseigne, M.D., Marc Ychou, M.D., Ph.D., Olivier Bouché, M.D., Ph.D., Rosine Guimbaud, M.D., Ph.D., Yves Bécouarn, M.D., Antoine Adenis, M.D., Ph.D., Jean-Luc Raoul, M.D., Ph.D., Sophie Gourgou-Bourgade, M.Sc., Christelle de la Fouchardière, M.D., Jaafar Bennouna, M.D., Ph.D., Jean-Baptiste Bachet, M.D., Faiza Khemissa-Akouz, M.D., Denis Péré-Vergé, M.D., Catherine Delbaldo, M.D., Eric Assenat, M.D., Ph.D., Bruno Chauffert, M.D., Ph.D., Pierre Michel, M.D., Ph.D., Christine Montoto-Grillot, M.Chem., and Michel Ducreux, M.D., Ph.D.
N Engl J Med 2011; 364:1817-1825May 12, 2011

Written by Christian Nordqvist