November 30, 2020
Pancreatic ductal adenocarcinoma (PDAC) is a highly fatal malignant disease. Nearly 80–85% of patients presented with locally advanced or metastatic diseases at the time of diagnosis, and the overall 5-year survival rate is about 8% globally. Systemic chemotherapy is the standard of care for patients with unresectable advanced or metastatic pancreatic cancer.
Two common regimens including folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX), along with nab-paclitaxel plus gemcitabine (AG), showed therapeutic efficacies as a first-line chemotherapy in patients with metastatic PDAC, achieving a median overall survival of 8.5–11.1 months. However, the FOLFIRINOX and AG regimens are both associated with a considerably high degree of hematological toxicity, notably grade III/IV neutropenia in Asians. On the behalf of the National Health Research Institutes’ Taiwan Cooperative Oncology Group, Dr. Li-Tzong Chen and Dr. Nai-Jung Chiang initiated a phase I/II clinical trial (T1211) to use a novel chemotherapy regimen of oral S-1, leucovorin, oxaliplatin, and gemcitabine (SLOG) for patients with metastatic PDAC in Taiwan. Treatment consisted of a fixed-rate (10 mg/m2/min) of 800 mg/m2 gemcitabine followed by 85 mg/m2 oxaliplatin on day 1, plus 35 mg/m2 oral S-1 twice daily (maximum dose of 120 mg daily) and leucovorin (15 mg twice daily) from day 1 to 7, every 2 weeks per cycle. Seventy-three patients were enrolled in this study. The results demonstrated promising efficacies, with the objective response rate of 40.7% (95% confidence interval [CI], 28%–55%), the median progression-free survival of 7.6 (95% CI, 5.6–11.0), and overall survival of 11.4 (95% CI, 8.1–16.3) months in the phase II part. The toxicity profile was favorable and tolerable. The regimen is already being applied in clinical practice for patients with metastatic PDAC. Further study to apply the regimen to the treatment of locally advanced PDAC is ongoing. In conclusion, biweekly SLOG is a feasible regimen with promising activity and safety profiles in the treatment of metastatic PDAC.
The findings of the study were published in the European Journal of Cancer in January 2020.
For the full text of the relevant publication, visit https://www.ejcancer.com/article/S0959-8049(19)30795-6/fulltext
For further information, contact Dr. Nai-Jung Chiang at +886-6-700-0123 ext. 65148.