First-line fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) resulted in a median overall survival of 24.2 months in patients with locally advanced pancreatic cancer, longer than the 6 to 13 months reported with gemcitabine, a meta-analysis published in the journal The Lancet Oncology has shown.1

Because several studies have investigated the efficacy of systemic chemotherapy with FOLFIRINOX in patients with locally advanced pancreatic cancer, researchers sought to conduct a systematic review of the FOLFIRINOX studies to evaluate its effectiveness as frontline therapy in this patient population.

For the study, researchers analyzed data from 315 patients with locally advanced disease who received first-line FOLFIRINOX in 11 studies. Results showed that median overall survival from the initiation of chemotherapy ranged from 10.0 months (95% CI, 4.0-16.0) to 32.7 months (95% CI, 23.1-42.3) across the 11 studies. The pooled patient-level median overall survival was 24.2 months (95% CI, 21.7-26.8).

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Researchers found that median progression-free survival ranged from 3.0 months (95% CI, not calculable) to 20.4 months (95% CI, 6.5-34.3) across the studies. Patient-level median progression-free survival was 15.0 months (95% CI, 13.8-16.2).

In terms of safety, 296 grade 3 or 4 adverse events among 490 patients from 10 studies. No deaths were related to FOLFIRINOX therapy.

The study further demonstrated that 57% of 271 patients from 8 studies received radiotherapy or chemoradiotherapy after FOLFIRINOX treatment. A total of 63.5% (95% CI, 43.3-81.6) of patients received radiation treatment and 25.9% (95% CI, 20.2-31.9) underwent resection after FOLFIRINOX. The pooled proportion of patients who had R0 resection was 78.4% (95% CI, 60.2-92.2).

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These promising findings ultimately suggest that they should be further evaluated in a randomized controlled trial, and future research should determine which patients might benefit from radiotherapy, chemoradiotherapy, or resection following FOLFIRINOX treatment.


  1. Suker M, Beumer BR, Sadot E, et al. FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis [published online ahead of print May 6, 2016]. Lancet Oncol. doi: 10.1016/S1470-2045(16)00172-8.