title: Feasibility of alternating induction and maintenance chemotherapy in pancreatic cancer.
abstract: Chemotherapy regimens for pancreatic ductal adenocarcinoma (PDAC) have changed since the introduction of FOLFIRINOX. Due to toxicity, dosage and number of applied cycles are limited. In analogy to chemotherapy strategies in colon cancer we used a scheme of induction, maintenance and re-induction therapy in PDAC to alleviate such toxicities and increase the number of applied cycles. Here we report first experiences with this approach. Data of all patients who received FOLFIRINOX for metastatic or locally advanced PDAC in our center using induction chemotherapy followed by maintenance therapy from 2011 until November 2016 was collected and analyzed retrospectively. Progression free survival was assessed starting induction therapy until progressive disease (PD) during maintenance or treatment pause (PFS1) and until progression during re-induction therapy (PFS2). 13 patients received induction therapy which was followed by maintenance therapy. Re-induction due to PD during therapy was applied in 11 patients. The median PFS1 was 10.6 months (95% CI; 6.7-14.4), PFS2 was 14.1 months (95% CI; 8.2-19.9) and overall survival was 18.3 months (95% CI; 14.8-21.8). The use of FOLFIRINOX as induction, followed by maintenance and re-induction therapy in case of PD is feasible in the treatment of PDAC and might lead to a prolonged PFS with less toxicity.
authors.affiliation: Department of General Internal Medicine and Gastroenterology, Katharinenhospital, Stuttgart, Germany.|Department of Internal Medicine I, Ulm University, Ulm, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hann
authors.affiliation: Department of General Internal Medicine and Gastroenterology, Katharinenhospital, Stuttgart, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Bohle
authors.affiliation: Institute for Computer Graphics and Vision, Graz University of Technology, Austria.
authors.forename: Jan
authors.initials: J
authors.lastname: Egger
authors.affiliation: Department of General Internal Medicine and Gastroenterology, Katharinenhospital, Stuttgart, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Zoller
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D019233:Retreatment; D016019:Survival Analysis; D016896:Treatment Outcome