FOLFIRINOX Shows Promise in Locally Advanced Pancreatic Cancer

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(ChemotherapyAdvisor) – Despite “significant toxicity,” the FOLFIRINOX chemotherapy regimen is associated with clinical responses among patients with locally advanced pancreatic ductal adenocarcinoma (LAPD), according to a small retrospective single-institution study presented at the 66th Annual Society of Surgical Oncology (SSO) Cancer Symposium in National Harbor, MD.

“The high rates of pathologic response observed in this small cohort suggest that FOLFIRINOX alone or as part of a multimodality approach is a biologically active regimen in locally advanced pancreatic ductal adenocarcinoma,” reported Brian Boone, MD, and coauthors at the University of Pittsburgh in Pittsburgh, PA.

However, the authors noted a “considerable number of patients (16% [4 of 25]) who were recommended FOLFIRINOX ultimately did not undergo treatment with the regimen.”

“Future trials will need to account for significant toxicity and subject dropout,” they cautioned.

The FOLFIRINOX regimen involves combined treatment with 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin. FOLFIRINOX is associated with improved survival among patients with metastatic pancreatic cancer. However, there is limited information available on outcomes among patients treated with this regimen for LAPD, the authors noted.

The coauthors studied medical records for 25 patients with LAPD who were recommended FOLFIRINOX at the high-volume Pancreatic Specialty Care Center in Pittsburgh. Most patients (52%) had unresectable tumors and the others (48%) had borderline resectable tumors, the team noted.

Twenty-one of the patients were treated with a median of five cycles (range, 2-8 cycles) of FOLFIRINOX. Fifteen patients underwent additional chemotherapy or radiotherapy before surgery, the authors noted.

Thirteen (52%) of the patients experienced radiologically identified tumor response but major pathologic responses occurred in fewer patients.

“A total of four patients (19%) demonstrated major pathologic response after receiving FOLFIRINOX (two complete pathologic responses and two near complete responses),” the researchers reported.

The abstract (#75) for this presentation is available at the 66th Annual SSO Cancer Symposium's website.

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