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PANOPTIMOX showed that people whose pancreatic cancer is controlled after four months of FOLFIRINOX can drop to a gentler fluorouracil maintenance without losing survival, living longer before their quality of life fell; the alternating gemcitabine strategy did worse.
PANOPTIMOX-PRODIGE 35 randomised 276 patients (mean age 63) between January 2015 and November 2016: arm A six months of FOLFIRINOX (91), arm B four months of FOLFIRINOX then leucovorin plus fluorouracil maintenance in controlled patients (92), arm C sequential gemcitabine and FOLFIRI.3 alternating every two months (90). Six-month progression-free survival was 47.1, 42.9 and 34.1 percent and median overall survival 10.1, 11.2 and 7.3 months. Median survival without deterioration in quality-of-life scores was 11.4 months in the maintenance arm against 7.2 and 7.5 months, but grade 3 or 4 neurotoxicity was higher with maintenance (19.8 against 10.2 percent), probably because more oxaliplatin was delivered (92 against 83 percent of the target dose). The maintenance strategy became an accepted way to give FOLFIRINOX and the platform on which POLO-style maintenance questions sit for patients without a BRCA mutation.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
276 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival at 6 monthsprimary | FOLFIRINOX 6 months | 91 | 47.1% | - | - | link |
| FOLFIRINOX 4 months then LV5FU2 maintenance | 92 | 42.9% | ||||
| Alternating gemcitabine and FOLFIRI.3 | 90 | 34.1% | ||||
| Overall survival | FOLFIRINOX 6 months | - | 10.1 months | - | - | link |
| FOLFIRINOX 4 months then LV5FU2 maintenance | - | 11.2 months | ||||
| Alternating gemcitabine and FOLFIRI.3 | - | 7.3 months |
Shares Quality of life, Leucovorin (folinic acid), FOLFIRINOX / mFOLFIRINOX, Fluorouracil (5-FU).
Shares Fluorouracil (5-FU), Gemcitabine, Metastatic pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy.
Shares Peripheral neuropathy (chemotherapy-induced), Leucovorin (folinic acid), Fluorouracil (5-FU), Metastatic pancreatic ductal adenocarcinoma.
Shares Leucovorin (folinic acid), Gemcitabine, Metastatic pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy.
Shares Leucovorin (folinic acid), Fluorouracil (5-FU), Metastatic pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy.
Shares Leucovorin (folinic acid), Fluorouracil (5-FU), Metastatic pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy.
Shares Leucovorin (folinic acid), Fluorouracil (5-FU), Metastatic pancreatic ductal adenocarcinoma, Cytotoxic chemotherapy.
Shares Quality of life, Fluorouracil (5-FU), Gemcitabine, Metastatic pancreatic ductal adenocarcinoma.