Welcome to Partners in Pancreatic Cancer. I am Dr. Ramesh Ramanathan from the Mayo Clinic in Phoenix, Arizona. I am frequently asked, “Where does oxaliplatin fit in the treatment paradigm for advanced pancreatic cancer?”
Oxaliplatin in combination with 5-FU, in the U.S. is the FOLFOX regimen; it is frequently used as a second-line regimen. Recently, based on a clinical trial from Canada, the NCIC study compared 5-FU by 4- to 6-hour infusion to a modified FOLFOX regimen. This regimen is no longer widely used, and the reason is because the results of this study showed that oxaliplatin with 5-FU did not improve the outcomes, and in fact had more toxicity. This is supported by a meta-analysis from my colleagues at Mayo Clinic who looked at second-line therapy in combination with 5-FU of oxaliplatin or irinotecan where oxaliplatin did not improve overall survival. We now have an effective second-line regimen which is 5-FU and MM-398, or ONIVYDE, and I think that is a better second-line regimen than FOLFOX. Most patients who have second-line therapy typically will have FOLFIRINOX, or gemcitabine and nab-paclitaxel and also have some baseline neuropathy where oxaliplatin is suitable. I think, in conclusion, oxaliplatin has a diminishing role as second-line therapy. Thank you for viewing this activity.