Editors' ChoiceProstate Cancer

Old Dogs and New Tricks

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Science Translational Medicine  01 Jun 2011:
Vol. 3, Issue 85, pp. 85ec81
DOI: 10.1126/scitranslmed.3002687

Pancreatic cancer was the fourth deadliest cancer in the United States in 2010. The standard of care for pancreatic cancer over the past decade has been the cytotoxic chemotherapy gemcitabine, a nucleoside analog. However, gemcitabine does not cure pancreatic cancer: The median overall survival with single-agent gemcitabine ranges from 5.0 to 7.2 months, with minimal improvement in combination therapies. New therapies are being sought, but even in the new era of targeted therapy, a long line of trials using new molecules have not resulted in any clear and meaningful improvement in overall survival.

Now, a recently published study by Conroy et al. has nearly doubled the length of survival for this deadly disease. The authors use a surprising regimen that consists of a combination of standard cytotoxic chemotherapies that have been used in other cancers for years. FOLFIRINOX—a combination of oxaliplatin, irinotecan, leucovorin, and fluorouracil—resulted in a median overall survival in the FOLFIRINOX group of 11.1 months as compared with 6.8 months in gemcitabine group. However, the FOLFIRINOX regimen did show an increase in toxicity that may limit its use in some patients. Nevertheless, these unexpected results will change the standard of care for this disease. The success of this new regimen using old drugs provides hope that other new regimens using existing standard chemotherapies may be beneficial in other cancer types.

T. Conroy et al., FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N. Engl. J. Med. 364, 1817–1825 (2011). [Full Text]

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