Neoadjuvant FIRINOX for Borderline Resectable Pancreatic Cancer - a Pilot Study

Study Overview
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Brief Summary
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FOLFIRINOX regimen was recently presented at an international oncology meeting and represents a new standard regimen in the treatment of metastatic pancreatic cancer. FOLFIRINOX is one of the high response rate treatment regimen , the investigators considered as a promising treatment as neoadjuvant chemotherapy . On the other hand , incidences of grade 3 or 4 neutropenia , febrile neutropenia and diarrhea were significantly higher in the FOLFIRINOX group compared with gemcitabine group. Therefore, it was decided to consider the balance of safety and efficacy as a preoperative chemotherapy, the investigators use the FIRINOX regimen by eliminating LV and bolus 5-FU, and irinotecan reduced to 150mg/m2 of 180mg/m2 from FOLFIRINOX regimen

Detailed Description
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FOLFIRINOX regimen was recently presented at an international oncology meeting and represents a new standard regimen in the treatment of metastatic pancreatic cancer. FOLFIRINOX is one of the high response rate treatment regimen , the investigators considered as a promising treatment as neoadjuvant chemotherapy . On the other hand , incidences of grade 3 or 4 neutropenia , febrile neutropenia and diarrhea were significantly higher in the FOLFIRINOX group compared with gemcitabine group. Therefore, it was decided to consider the balance of safety and efficacy as a preoperative chemotherapy, the investigators use the FIRINOX regimen by eliminating LV and bolus 5-FU, and irinotecan reduced to 150mg/m2 of 180mg/m2 from FOLFIRINOX regimen. The investigators also evaluate the optimal treatment schedule of FIRINOX therapy as neoadjuvant chemotherapy, optimal duration between surgery and chemotherapy, R0 resection rate, and resection rate for borderline resectable pancreatic cancer.

Official Title
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The Pilot Study of Neoadjuvant Chemotherapy of FIRINOX for Patients With Borderline Resectable Pancreatic Cancer

Conditions
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Patients With Borderline Resectable Pancreatic Cancer

Intervention / Treatment
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* Drug: FIRINOX


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pathologically proven invasive pancreatic ductal carcinoma Cases that meet the definition of borderline resectable pancreatic cancer 1) or 2) Definition of a borderline resectable pancreatic cancer is filledin NCCN guideline version 1.2014 pancreatic adenocarcinoma Patients indicated distal pancreatectomy with en bloc celiac axis resection PS (ECOG) 0-1 ≧20 years old and < 75 years old First line treatment The following criteria must be satisfied in laboratory tests within 14 days of registration White blood cell count ≦12,000/mm3 Neutrophil count ≧1,500/mm3 Platelet count ≧100,000mm3 Total bilirubin <2.0mg/dL Serum Creatinine ≦upper limits of normal(ULN) AST, ALT≦2.5×ULN Albumin≧3.0g/dL Hemoglobin≧9.0g/dL Written informed consent to participate in this study Exclusion Criteria: Severe drug hypersensitivity Multiple primary cancers within 5 years Severe infection With grade2 or more severe peripheral neuropathy With intestinal paralysys, ileus Interstitial pneumonia or pulmonary With uncontrollable pleural effusion or ascites Receiving atazanavir sulfate With uncontrollable diabetes With uncontrollable heart failure, angina, hypertension, arrhythmia With severe psychological symptoms With watery diarrhea Pregnant or lactating women, or women with known or suspected pregnancy Inappropriate patients for entry on this study in the judgment of the investigator With UGT1A1*28 and/or UGT1A1*6 polymorphisms

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 74 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Optimal chemotherapy courses<br>Neoadjuvant chemotherapy 4 courses of FIRINOX early 5 patients, and 8 courses of FIRINOX subsequent 5 patients | Drug: FIRINOX<br>* FIRINOX regimen by eliminating LV and bolus 5-FU, and irinotecan reduced to 150mg/m2 of 180mg/m2 from FOLFIRINOX regimen.<br>* Other names: Oxaliplatin, Irinotecan, 5-FU.;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with toxicity of FIRINOX therapy as neoadjuvant chemotherapy for borderline resectable pancreatic cancer. | Toxicities will be assessed according to Common Terminology Criteria for Adverse Events (CTCAE) 4.0. | Up to 30 weeks. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The resection rate of FIRINOX therapy as neoadjuvant chemotherapy for borderline resectable pancreatic cancer. |  | Up to 24 weeks. | 
| The R0 resection rate of FIRINOX therapy as neoadjuvant chemotherapy for borderline resectable pancreatic cancer. |  | Up to 30 weeks. | 
| The optimal treatment schedule of FIRINOX therapy as neoadjuvant chemotherapy for borderline resectable pancreatic cancer. |  | Up to 2 years. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Borderline resectable pancreatic cancer, R0 resection, Resection rate, Optimal schedule