XELIRI or FOLFIRI as Salvage Therapy in Advanced Pancreatic Cancer

Background: More than half of patients with pancreatic adenocarcinoma (PA) are candidates for further treatment when they experience upfront treatment failure. Patients and Methods: Patients with gemcitabine-resistant PA, age 50 were treated with a XELIRI or FOLFIRI regimen until progressive disease or a maximum of six months. As this was an observational study, no statistical design was performed. Results: Between July 2007 and December 2009, 34 patients (median age 60 years; median KPS 90) were treated with XELIRI (26) or FOLFIRI (8) regimen. Grade >2 toxicity consisted of neutropenia in 9% of patients, anemia and fatigue in 3% and hand-foot syndrome in 12%. Median progression-free survival was two months (range 1-4). Maximum response was stable disease in four patients (12%). Median survival was 4.2 (range 1-15) months. Conclusion: Fluoropyrimidine and irinotecan combination does not seem to have any role in the treatment of gemcitabine-resistant PA. Virtually all patients with locally advanced or metastatic pancreatic adenocarcinoma present progressive disease (PD) during or immediately after first-line chemotherapy (1, 2). At time of failure, approximately half of patients maintain a good performance status (PS) and are willing to undergo further treatment. While gemcitabine or gemcitabine-based chemotherapy are routinely used as first-line treatments, no universally accepted second-line therapy exists and the therapeutic arsenal for both first-line and salvage therapy in pancreatic cancer is limited. Salvage treatment after gemcitabine-based chemotherapy failure is currently being investigated with mixed success (3-18). A randomized phase II trial has suggested that salvage chemotherapy may improve survival when compared to best supportive care (17). Furthermore, salvage treatment achieves a clinically significant improvement in quality of life in several domains (18). The identification of active drugs and regimens for second-line chemotherapy is therefore needed to provide more treatment opportunities to patients with gemcitabine-refractory pancreatic cancer. Irinotecan, a camptothecin analog, has been demonstrated to have a strong growth-inhibiting effect on