title: Optimizing initial chemotherapy for metastatic pancreatic cancer.
abstract: The two combination chemotherapy regimens FOLFIRINOX and gemcitabine plus nab-paclitaxel represent major breakthroughs in the management of metastatic pancreatic cancer. Both regimens showed unprecedented survival advantage in the setting of front-line therapy. However, their application for treatment of patients in the community is challenging because of significant toxicities, thus limiting potential benefits to a narrow population of patients. Modifications to the dose intensity or schedule of those regimens improve their tolerability, while likely retaining survival advantage over single-agent chemotherapy. Newer strategies to optimize these two active regimens in advanced pancreatic cancer are being explored that can help personalize treatment to individual patients.
authors.affiliation: The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA.
authors.forename: Kalyan C
authors.initials: KC
authors.lastname: Mantripragada
authors.affiliation: The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Safran
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D000093542:Gemcitabine
chemical_list: D009944:Organoplatinum Compounds; D003841:Deoxycytidine; D002955:Leucovorin; D005472:Fluorouracil; D000093542:Gemcitabine
keywords: ACCORD 11; FOLFIRINOX; MPACT; PRODIGE 4; abraxane; dose modification; gemcitabine; modified; nab-paclitaxel; neutropenia; pancreatic cancer; toxicity