Abstract
Interferon alpha-2a (IFN-alpha) and folinic acid (FA) have been shown to modulate the cytotoxic effects of 5-fluorouracil (5-FU) in the treatment of cancer. A phase II study was initiated to evaluate the effect of a combination of 5-FU/FA/IFN-alpha in patients with advanced pancreatic cancer. Sixty previously untreated patients with advanced adenocarcinoma of the pancreas were treated with 500 mg m-2 FU via an intravenous bolus 1 h after the initiation of a 2 h infusion of 500 mg m-2 FA. Before starting the FA infusion, 6 million units (MU) of IFN-alpha was administered subcutaneously. The treatment was repeated once a week. Of 57 evaluable patients, eight (14%) had a partial response (PR), eight (14%) a minor response (MR) and 28 (49%) no change of disease (NC). Thirteen patients (23%) had progressive disease (PD). The median survival time was 10 months for all patients, 22 months for patients with partial remission and 5 months for patients with progressive disease. Many patients with tumour-related pain whose tumours were affected in terms of PR, MR, NC were free of pain during treatment with this regimen (22/36 patients). The common toxicities observed were fever (56%), nausea (37%) and diarrhoea (33%). These data suggest that biochemical modulation of 5-FU with FA and IFN-alpha has some positive effects in the treatment of pancreatic cancer of moderate toxicity.
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- Bukowski R. M., Inoshita G., Yalavarthi P., Murthy S., Gibson V., Budd G. T., Sergi J. S., Bauer L., Prestifilippo J. A phase I trial of 5-fluorouracil, folinic acid, and alpha-2a-interferon in patients with metastatic colorectal carcinoma. Cancer. 1992 Feb 15;69(4):889–892. doi: 10.1002/1097-0142(19920215)69:4<889::aid-cncr2820690409>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
- Crown J., Casper E. S., Botet J., Murray P., Kelsen D. P. Lack of efficacy of high-dose leucovorin and fluorouracil in patients with advanced pancreatic adenocarcinoma. J Clin Oncol. 1991 Sep;9(9):1682–1686. doi: 10.1200/JCO.1991.9.9.1682. [DOI] [PubMed] [Google Scholar]
- Cullinan S., Moertel C. G., Wieand H. S., Schutt A. J., Krook J. E., Foley J. F., Norris B. D., Kardinal C. G., Tschetter L. K., Barlow J. F. A phase III trial on the therapy of advanced pancreatic carcinoma. Evaluations of the Mallinson regimen and combined 5-fluorouracil, doxorubicin, and cisplatin. Cancer. 1990 May 15;65(10):2207–2212. doi: 10.1002/1097-0142(19900515)65:10<2207::aid-cncr2820651007>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
- DeCaprio J. A., Mayer R. J., Gonin R., Arbuck S. G. Fluorouracil and high-dose leucovorin in previously untreated patients with advanced adenocarcinoma of the pancreas: results of a phase II trial. J Clin Oncol. 1991 Dec;9(12):2128–2133. doi: 10.1200/JCO.1991.9.12.2128. [DOI] [PubMed] [Google Scholar]
- Ernstoff M. S., Lembersky B. C., Kirkwood J. M. Fluorouracil, interferon-alpha, and colon cancer: rational pursuit of synergism between antimetabolites and biologicals. J Clin Oncol. 1989 Dec;7(12):1764–1765. doi: 10.1200/JCO.1989.7.12.1764. [DOI] [PubMed] [Google Scholar]
- Grem J. L., Chu E., Boarman D., Balis F. M., Murphy R. F., McAtee N., Allegra C. J. Biochemical modulation of fluorouracil with leucovorin and interferon: preclinical and clinical investigations. Semin Oncol. 1992 Apr;19(2 Suppl 3):36–44. [PubMed] [Google Scholar]
- Kelsen D., Hudis C., Niedzwiecki D., Dougherty J., Casper E., Botet J., Vinciguerra V., Rosenbluth R. A phase III comparison trial of streptozotocin, mitomycin, and 5-fluorouracil with cisplatin, cytosine arabinoside, and caffeine in patients with advanced pancreatic carcinoma. Cancer. 1991 Sep 1;68(5):965–969. doi: 10.1002/1097-0142(19910901)68:5<965::aid-cncr2820680509>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
- Knuth A., Bernhard H., Klein O., Meyer zum Büschenfelde K. H. Combination fluorouracil, folinic acid, and interferon alfa-2a: an active regimen in advanced pancreatic carcinoma. Semin Oncol. 1992 Apr;19(2 Suppl 3):211–214. [PubMed] [Google Scholar]
- Miller A. B., Hoogstraten B., Staquet M., Winkler A. Reporting results of cancer treatment. Cancer. 1981 Jan 1;47(1):207–214. doi: 10.1002/1097-0142(19810101)47:1<207::aid-cncr2820470134>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
- Pazdur R., Ajani J. J., Abbruzzese J. L., Belt R. J., Dakhil S. R., Dubovsky D., Graham S., Pilat S., Winn R., Levin B. Phase II evaluation of fluorouracil and recombinant alpha-2a-interferon in previously untreated patients with pancreatic adenocarcinoma. Cancer. 1992 Oct 15;70(8):2073–2076. doi: 10.1002/1097-0142(19921015)70:8<2073::aid-cncr2820700810>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
- Petrelli N., Douglass H. O., Jr, Herrera L., Russell D., Stablein D. M., Bruckner H. W., Mayer R. J., Schinella R., Green M. D., Muggia F. M. The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Gastrointestinal Tumor Study Group. J Clin Oncol. 1989 Oct;7(10):1419–1426. doi: 10.1200/JCO.1989.7.10.1419. [DOI] [PubMed] [Google Scholar]
- Petrelli N., Herrera L., Rustum Y., Burke P., Creaven P., Stulc J., Emrich L. J., Mittelman A. A prospective randomized trial of 5-fluorouracil versus 5-fluorouracil and high-dose leucovorin versus 5-fluorouracil and methotrexate in previously untreated patients with advanced colorectal carcinoma. J Clin Oncol. 1987 Oct;5(10):1559–1565. doi: 10.1200/JCO.1987.5.10.1559. [DOI] [PubMed] [Google Scholar]
- Scheithauer W., Pfeffel F., Kornek G., Marczell A., Wiltschke C., Funovics J. A phase II trial of 5-fluorouracil, leucovorin, and recombinant alpha-2b-interferon in advanced adenocarcinoma of the pancreas. Cancer. 1992 Oct 1;70(7):1864–1866. doi: 10.1002/1097-0142(19921001)70:7<1864::aid-cncr2820700709>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
- Sobrero A., Nobile M. T., Guglielmi A., Mori A., Aschele C., Bolli E., Tixi L., Gallo L., Parodi G. C., Bruzzi P. Phase II study of 5-fluorouracil plus leucovorin and interferon alpha 2b in advanced colorectal cancer. Eur J Cancer. 1992;28A(4-5):850–852. doi: 10.1016/0959-8049(92)90130-t. [DOI] [PubMed] [Google Scholar]
- Wadler S., Schwartz E. L., Goldman M., Lyver A., Rader M., Zimmerman M., Itri L., Weinberg V., Wiernik P. H. Fluorouracil and recombinant alfa-2a-interferon: an active regimen against advanced colorectal carcinoma. J Clin Oncol. 1989 Dec;7(12):1769–1775. doi: 10.1200/JCO.1989.7.12.1769. [DOI] [PubMed] [Google Scholar]
- Warshaw A. L., Fernández-del Castillo C. Pancreatic carcinoma. N Engl J Med. 1992 Feb 13;326(7):455–465. doi: 10.1056/NEJM199202133260706. [DOI] [PubMed] [Google Scholar]
- Wils J. A. Chemotherapy in pancreatic cancer: a rational pursuit? Anticancer Drugs. 1991 Feb;2(1):3–10. doi: 10.1097/00001813-199102000-00001. [DOI] [PubMed] [Google Scholar]
- van der Wilt C. L., Pinedo H. M., Smid K., Cloos J., Noordhuis P., Peters G. J. Effect of folinic acid on fluorouracil activity and expression of thymidylate synthase. Semin Oncol. 1992 Apr;19(2 Suppl 3):16–25. [PubMed] [Google Scholar]