FOLFIRINOX for locally advanced or metastatic pancreatic cancer: a single institution retrospective review

Abstract

Background: First line treatment with FOLFIRINOX significantly increases overall survival (OS) in patients with metastatic pancreatic cancer compared with gemcitabine (Conroy et al. N Engl J Med, 2011). The aim of our retrospective institutional review is to evaluate the efficacy and tolerability of this regimen in unresectable pancreatic cancer. Methods: All patients had received >1 cycle of standard FOLFIRINOX as first line between July 2011 and December 2014 were identified. Charts and electronic records were reviewed for clinical characteristics, toxicities, response rates (RR), progression free survival (PFS) and OS. PFS and OS were calculated from day1 of FOLFIRINOX and estimated by Kaplan-Meier method. Results: The characteristics of the 32 patients were as follows: median age, 60 years (range, 28 to 69); male/female, 21/11; PS 0/1, 16/16; UICC-TNM stageIII/IV, 11/21; primary site head/body-tail, 12/20; biliary intervention yes/no, 8/24; UGT1A1 genetic polymorphisms wild type/*6 heterozygous/*28 heterozygous, 23/3/6. The median number of cycles performed was 6 (range, 1 to 22). 6 patients achieved partial response and 18 patients had stable disease. The overall RR was 19% and the disease control rate was 75%. one patient with locally advanced disease has subsequently undergone R0 resection. The median PFS was 3.1 months and median OS was 9.9 months. The adverse events of grade 3/4 included neutropenia in 23 patients (72%), febrile neutropenia in 8 patients (25%), anorexia and nausea in 7 patients (22%), and diarrhea in 1 patient (3%), respectively. There were no treatment-related deaths. Conclusion: Despite this retrospective series examines FOLFIRINOX in highly selected patients, our results does not match those seen in clinical trials. FOLFIRINOX appears to be associated with manageable, but significant toxicities. Careful selection of patients and monitoring of toxicities are needed.