Modified FOLFIRINOX as initial treatment of advanced pancreatic cancer: A single cancer center experience.

Background: The FOLFIRINOX regimen has been shown to significantly increase both overall (OS) and progression free (PFS) survival in metastatic pancreas cancer (MPC), compared to gemcitabine. However this regimen is associated with significant toxicity. The purpose of our analysis was to evaluate the efficacy and safety of modified FOLFIRINOX with 25% dose reduction of oxaliplatin, irinotecan and 5-fluorouracil administered every 2 weeks without profylactic growth factors in pacient with advanced pancreatic adenocarcinoma. Methods: A retrospective analysis was conducted on all patients treated with modified FOLFIRINOX for advanced pancreatic cancer between January 2013 and December 2014. The primary objective was to evaluate the efficacy and safety of FOLFIRINOX when used with dose modifications. Toxicity was graded as per CTCAE version 4.0. Results: A total of 26 patients were identified (10 locally advanced, 16 metastatic). The median age was 61,6 (range 43-69) and at baseline all patients had an ECOG performance status of 0 or 1 (46% and 54% respectively). The primary tumour was located in the head of the pancreas in 46% of patients and 19% of patients had a biliary stent. The median number of FOLFIRINOX cycles administered was 8,5 (range 2-19) but 15% of patients currently remain on treatment. Response rate was 38% (all achieved a partial response) and 19% achieved stable disease. Three patients (11,5%) with locally advanced pancreatic cancer became suitable for curative surgical resection following chemotherapy. The median PFS was 7,3 month (in locally advanced 7,95 months and in metastatic 7,02 months). The median overall survival was 17,54 months (in locally advanced 16,96 months and in metastatic 17,86 months). The treatment was very well tolerated without neutropenia G3/4 or febrile neutropenia. Grade 3/4 non-hematologic AEs were observed in 25% of pts, including vomiting (15%), nausea (11%) and diarrhea (7%). Conclusions: In patients with advanced pancreatic cancer in good performance status (0-1) FOLFIRINOX may lead to a significant prolongation of time to progression and overall survival with good quality of life even with dose reduction.

 

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