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. 2014 Aug;19(8):845-50.
doi: 10.1634/theoncologist.2014-0106. Epub 2014 Jun 20.

FOLFOX-4 chemotherapy for patients with unresectable or relapsed peritoneal pseudomyxoma

Filippo Pietrantonio  1 , Claudia Maggi  2 , Giuseppe Fanetti  2 , Roberto Iacovelli  2 , Maria Di Bartolomeo  2 , Francesca Ricchini  2 , Marcello Deraco  2 , Federica Perrone  2 , Dario Baratti  2 , Shigeki Kusamura  2 , Elena Tamborini  2 , Alessandra Castano  2 , Paola Valentina Consonni  2 , Ilaria Bossi  2 , Cecilia Gavazzi  2 , Massimo Milione  2 , Giuseppe Pelosi  2 , Filippo de Braud  2
Affiliations

FOLFOX-4 chemotherapy for patients with unresectable or relapsed peritoneal pseudomyxoma

Filippo Pietrantonio et al. Oncologist. 2014 Aug.

Abstract

Purpose: The standard treatment of peritoneal pseudomyxoma is based on cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The establishment of newer systemic treatments is an unmet clinical need for unresectable or relapsed peritoneal pseudomyxoma. The aim of our study was to assess the activity of chemotherapy with 5-fluorouracil and oxaliplatin (FOLFOX-4 regimen) in terms of response rate in this subset of patients.

Materials and methods: Patients were included in a single-center, observational study and treated with FOLFOX-4 administered every 2 weeks for up to 12 cycles or until progressive disease or unacceptable toxicity.

Results: Twenty consecutive patients were reviewed from July 2011 to September 2013. Only partial responses were observed, with an objective response rate of 20%. Median progression-free survival and overall survival were 8 months and 26 months, respectively. Two patients were able to undergo laparotomy with complete cytoreduction and HIPEC in one case. Safety data for FOLFOX-4 were consistent with the literature. By means of a mutant enriched polymerase chain reaction, KRAS mutation was found in 16 of 19 cases (84%), and MGMT promoter methylation was found in 8 (42%, all KRAS mutant).

Conclusion: FOLFOX-4 chemotherapy is tolerable and active in patients with peritoneal pseudomyxoma when disease is deemed unresectable or relapsed after peritonectomy and HIPEC. The identification of predictive biomarkers, such as KRAS for resistance to anti-epidermal growth factor receptor monoclonal antibodies and MGMT for response to temozolomide, is a priority for the development of evidence-based treatment strategies for peritoneal pseudomyxoma.

Keywords: Appendiceal cancer; Chemotherapy; FOLFOX-4; Peritoneal pseudomyxoma.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curve for progression-free survival of the study population.
Figure 2.
Figure 2.
Kaplan-Meier curve for overall survival of the study population.
See this image and copyright information in PMC

Comment in

  • Challenges of efficacy assessments in pseudomyxoma peritonea.
    Overman MJ, Eng C, Raghav K, Matamoros A, Taggart M, Foo WC, Fournier K. Overman MJ, et al. Oncologist. 2015 Mar;20(3):e3-4. doi: 10.1634/theoncologist.2014-0415. Oncologist. 2015. PMID: 25745054 Free PMC article.
  • In reply.
    Baratti D, Kusamura S, Maggi C, de Braud F, Deraco M, Di Bartolomeo M, Pietrantonio F. Baratti D, et al. Oncologist. 2015 Mar;20(3):e5. doi: 10.1634/theoncologist.2014-423. Oncologist. 2015. PMID: 25745055 Free PMC article.

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