PRODIGE 98 : Randomized, Multicenter Phase 3 Trial of Adjuvant Chemotherapy With Modified FOLFIRINOX Versus Capecitabine or Gemcitabine in Patients With Resected Ampullary Adenocarcinoma

Inclusion criteria

• Histologically proven adenocarcinoma on surgical specimen
• Macroscopically complete surgical resection of an ampullary adenocarcinoma (R0 or R1)
• Adenocarcinoma removed within 12 weeks prior to enrollment
• Patients ≥ 18 years of age
• Patient without metastatic disease on CT scan < 4 weeks prior to inclusion
• WHO performance status 0 or 1 (WHO 0 if age >75)
• Normal values of kalemia, magnesemia and calcemiaPatient able to understand and sign the information and informed consent note
• Women of childbearing age and men who are sexually active with women of childbearing age must agree to use highly effective contraception during the trial treatment at least until 6 months after the end of experimental treatment. Women of childbearing potential must use highly effective contraception at least 9 months after the end of treatment with oxaliplatin
• Patient affiliated to a social security scheme for France, or equivalents in European countries
• CA19.9 level < 180 U/L at inclusion (post-operative level)

Exclusion criteria

• Neoadjuvant systemic chemotherapy
• pT1N0M0 tumors
• Active infection by HBV, HCV or HIV
• Dihydropyrimidine dehydrogenase deficiency (uracilemia ≥ 16 ng/mL)
• Pre-existing peripheral neuropathy (grade ≥ 2)
• Unresolved or uncontrolled concomitant medical conditions
• Neutrophils < 1500/mm3, platelets < 150 000/mm3, Haemoglobin < 9 g/dL
• Total bilirubin > 1.5x normal,
• Creatinine clearance < 50 ml/min according to MDRD
• AST or ALT > 2.5 x UNL, alkaline phosphatase > 2.5x normal at least 15 days after resection
• Patients with poor nutritional status represented by albuminemia < 30.0g/dl
• History of myocardial infarction within the last 6 months, severe coronary artery disease or severe heart failure
• Active and/or potentially severe infection
• Treatment with a strong cytochrome P450 inhibitor within 4 weeks prior to the administration of the protocol treatment (Treatment with Hypericum perforatum)
• Patient under treatment by brivudine, or treated by brivudine within 4 weeks prior to beginning of study treatment
• Concomitant use with St John's Wort
• QT/QTc interval longer than 450msec for men and longer than 470msec for women on the ECG
• Hypersensitivity to any of the study products or their excipients
• Administration of live vaccines within 28 days prior to randomization
• Other cancer treated within the last 5 years except adequately treated, in situ cervical carcinoma or basocellular/spinocellular carcinoma
• chronic bowel disease requiring specific treatment and/or intestinal obstruction
• Pregnant or breastfeeding woman
• Person under guardianship
• Inability to undergo the medical follow-up of the trial for geographical, social or psychological reasons