P-182 Institution experience of FOLFIRINOX chemotherapy in advanced pancreatic cancer

Abstract

Introduction: Combination chemotherapy with FOLFIRINOX is widely recognised as the most active combination chemotherapy regimen for advanced pancreatic cancer, but is a tough and toxic regimen with many side effects and potential for hospital admissions. There is a key focus on time away from hospital and quality of life in this patient group where time is short, palliation is the priority and cure not possible.We therefore audited our practice of patients receiving this regimen over a 2 year period with particular focus on admissions. Methods: Using the electronic chemotherapy prescribing system, and other electronic patient records, the case notes and chemotherapy prescriptions were reviewed for all patients allocated to receive FOLFIRINOX chemotherapy for advanced pancreatic cancer in Sussex in the south of England over a 2 year period - Dec 2013 - Nov 2015. Data were collected on patient demographics, cancer stage, site of known metastases, baseline albumin and Ca19.9 tumour marker level, and then number of treatments received, response and admissions to hospital during treatment. Results: Between December 2013 and November 2015, 28 patients were treated with FOLFIRINOX chemotherapy for advanced pancreatic cancer through our institution. The average age of the patients was 60 (range 44 - 73) with a 3:2 male:female ratio. 17 (61%) had proven radiological metastatic disease at presentation of which the majority (11/17) were liver metastases. Of the 25 cases where the Ca19.9 tumour marker protein had been measured, it was elevated in 23, and significantly elevated (>5x upper limit of normal) in 18 (72%). Response rates to chemotherapy were 6/22 radiologically (27% RR) and 6/26 based on Ca19.9 fall (23% RR). There were 3 neutropenic septic episodes recorded resulting in patient admission. In total there were 25 patient inpatient admission episodes on treatment - 3 patients had 3 admissions, 5 had 2, and a further 9 patients had one admission during their treatment. The remaining 12 patients had no admissions recorded during their chemotherapy course. There was 1 «30 day death» linked to FOLFIRINOX chemotherapy - where a patient had died within 30days of their most recent dose of chemotherapy. Conclusion: The demographics, and cancer details of the patients treated in our audit are consistent with those patients treated in the clinical trials which demonstrated the benefit of this chemotherapy regimen. The response rates seen were also broadly similar. Our «real world» experience also highlights the not insignificant admission rate of patients on FOLFIRINOX with 25 in-patient episodes. However several of these admissions were with cancer related complications and not as a result of chemotherapy sequelae. This patient group needs close observation during treatment to ensure the quality of life and time away from hospital target is achieved in addition to meaningful cancer responses.