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Master Thesis

Efficacité et tolérance d'une tri-chimiothérapie par FOLFIRINOX dans le cancer du pancréas chez les sujets âgés

Abstract : Introduction: incidence of pancreatic adenocarcinoma increase with age. FOLFIRINOX is actually the most effective treatment for pancreatic adenocarcinoma. There is currently very few data on the use of FOLFIRINOX on elderly patients diagnosed with pancreatic adenocarcinoma. The aim of this study was to evaluate the efficacy and tolerance of FOLFIRINOX on elderly patients treated for pancreatic adenocarcinoma. Methods: we conducted a retrospective study in two centers between 2012 and 2018. We included patients with a pancreatic adenocarcinoma histologically prouved. Metastatic and locally advanced tumors were included. Patients were divided in three groups, according to there age : over 70 years, from 65 to 70 years and under 65. For survival analysis, the were also divided into two groups: metastatic patients with palliative chemotherapy by FOLFIRINOX and locally advanced tumors treated by induction chemotherapy with FOLFIRINOX. The primary endpoint was overall survival for metastatic patients. For the second group with locally advanced tumors, the primary endpoint was the porportion of patients finishing the chemotherapy initially planned. Univariable and multivariable analysis were done to explore the predictive factors of survival. Results: 217 patients were included : 80 patients were included in the over 70 years group, 53 were in the 65 to 70 years group and 84 patients in the under 65 group. Most patients were in good condition, PS 0-1. Seventy-two percent of patients had primary reduction on FOLFIRINOX doses in the first group (over 70). Sixty-eight percent had a reduction in the 65 to 70 group and 55% in the third group (p= 0,05). Median overall survival for metastatic patients was 12,9 months in the over 70 group, 11,8 months in the 65 to 70 years group and 9,8 months in the under 65 group. For the locally advanced group, 68% finished the planned chemotherapy in the over 70 group. There were 82% and 72% to finish the planned treatment in the two others groups, without significant difference. Predictive factors of survival were advanced age, neurotoxicity du to oxaliplatin (HR = 0,36, [CI 95% : 0,23 – 0,56], p < 0,0001) and hematotoxicity (HR = 0,30, [CI 95%: 0,12 – 0,80], p < 0,015). Tolerance was similar in the three groups. Conclusion: we showed that elderly, selected patients older than 70 years old andtreated for pancreatic adenocarcinoma by FOLFIRINOX survive the same way as the younger patients, with the same toxicity profile.
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Submitted on : Thursday, February 27, 2020 - 4:42:40 PM
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Cécile Herran. Efficacité et tolérance d'une tri-chimiothérapie par FOLFIRINOX dans le cancer du pancréas chez les sujets âgés. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02493315⟩

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