Irinotecan Combined with Gemcitabine, 5-Fluorouracil, Leucovorin, and Cisplatin (G-FLIP) is an Effective and Noncrossresistant Treatment for Chemotherapy Refractory Metastatic Pancreatic Cancer

Abstract

Background. Single agents have only modest activity as treatment for metastatic pancreatic cancer with response rates of less than 10% and median survivals of less than 6 months. Evaluations of single-agent gemcitabine and rubitecan as second-line treatment for relapsed pancreatic cancer have reported good patient tolerability and median survivals of 3.85 months and 4.7 months, respectively. Regimens incorporating two drugs have demonstrated encouraging activity and clinical impact compared with single-agent therapy. G-FLIP is a regimen designed to incorporate four active single agents into a tolerable and active combination. This analysis is a retrospective evaluation of the efficacy and safety of the G-FLIP regimen as second-line chemotherapy in a series of consecutively treated patients with metastatic pancreatic cancer.Methods. G-FLIP was administered over 48 hours and repeated every 2 weeks. Day 1 treatment consisted of sequentially administered gemcitabine 500 mg/m

Use of gemcitabine as a second-line treatment following chemotherapy with folfirinox for metastatic pancreatic adenocarcinoma

“…The present study reports the findings on a single center cohort of patients who received second-line gemcitabine treatment for advanced-stage pancreatic adenocarcinoma. A survival of 3.6 months with second-line chemotherapy was observed, which is in agreement with previous published data (Table I) (7)(8)(9)(10)14,15,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). Response to gemcitabine therapy at the first follow-up evaluation (at 2 months) impacted significantly the OS of the patients.…”

Irinotecan plus raltitrexed vs raltitrexed alone in patients with gemcitabine-pretreated advanced pancreatic adenocarcinoma

“…Comparable therapeutic results in gemcitabine-pretreated patients with advanced pancreatic adenocarcinoma have only occasionally been reported in the past, that is, in a pilot phase II study of irinotecan (Klapdor and Fenner, 2000) and for a rather complex combination regimen consisting of irinotecan, gemcitabine, 5-FU, leucovorin, and cisplatin (Kozuch et al, 2001). Other chemotherapeutic drugs, such as paclitaxel (Oettle et al, 2000), rubitecan (Stehlin et al, 1999), and irofulven (Weitman et al, 2001), a unique cytotoxic agent that is related to the mushroom-derived illudins, unfortunately, are only marginally effective or do not seem to hold their promise (D Von Hoff, personal communications).…”

Metastatic Pancreatic Cancer: Emerging Strategies in Chemotherapy and Palliative Care

“…A gemcitabine-based fourdrug combination, incorporating irinotecan in the previously described GFP, designated G-FLIP, was administered over 2 days in a biweekly fashion and evaluated in 34 patients at our institution. The overall response rate was 24%, and the median survival was 10.3 months [137]. Most of these patients had progressed on the GFP regimen, and yet, a significant response rate (24%) and stabilization rate (24%) were obtained after adding irinotecan.…”