<p>Modified FOLFIRINOX for unresectable locally advanced/metastatic pancreatic cancer. A real-world comparison of an attenuated with a full dose in a single center experience</p>

Abstract

Purpose: Metastatic pancreatic adenocarcinoma has a very poor prognosis. Although irinotecan, oxaliplatin and leucovorin-modulated fluorouracil (FOLFIRINOX) significantly increases survival in advanced pancreatic cancer, compared to employing only gemcitabine (GEM), toxicities have tempered enthusiasm for its use. Methods: This study retrospectively analyses the real-world clinical practice with full and attenuated doses of FOLFIRINOX in unselected patients with locally advanced unresectable or metastatic pancreatic cancer, treated at an Italian general hospital. Efficacy, tolerability, and toxicity were evaluated, and overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan–Meier method. Results: Fifty consecutive patients with advanced (13) or metastatic (37) pancreatic adenocarcinomas were treated with FOLFIRINOX at the Medical Oncology Unit, Piacenza General Hospital, North Italy. The first enrolled consecutive 18 patients (36%) of this series started the treatment with a full dose of the regimen, while the subsequent 32 (64%) consecutive patients received dose attenuation (−20% bolus fluorouracil and −25% irinotecan). In the entire group, the response rate, median OS, and median PFS were 30%, 10.1 months, and 5.6 months, respectively, with no differences in objective response in the 32 patients that received an attenuated dose compared with the 18 patients receiving a full dose of chemotherapy. However, neutropenia, anemia, fatigue, and vomiting were statistically increased in the 18 patients receiving a full dose compared with the 32 patients receiving an attenuated dose of FOLFIRINOX ( p <0.05). Conclusion: This study demonstrates the efficacy and tolerability of modified FOLFIRINOX in advanced and metastatic pancreatic cancer.

Comparison between FOLFIRINOX and gemcitabine plus nab-paclitaxel including sequential treatment for metastatic pancreatic cancer: a propensity score matching approach

“…In another aspect of tolerability, dose modification was more frequently in FFX group. The efficacy and tolerability of FFX with modified dose for unresectable PC demonstrated in several studies [ 20 , 21 ]. Modified FFX showed comparable survival outcomes compared to full dose regimen and less adverse events [ 20 ].…”

“…The efficacy and tolerability of FFX with modified dose for unresectable PC demonstrated in several studies [ 20 , 21 ]. Modified FFX showed comparable survival outcomes compared to full dose regimen and less adverse events [ 20 ]. Appropriate dose modification and tolerance to chemotherapy would provide patients with more chances for second-line treatment, and more patients in the FFX group received second-line chemotherapy in this study.…”

Neoadjuvant Treatment in Locally Advanced Pancreatic Cancer (LAPC) Patients with FOLFIRINOX or Gemcitabine NabPaclitaxel: A Single-Center Experience and a Literature Review

“…Regarding the use of the mFFN scheme, Khushman and colleagues [40] demonstrated that the dose intensity and duration were associated with increased survival, arguing against dose attenuated versions of this regimen. Opposite to this study, several studies recently demonstrated that the reduced doses of the FFN scheme did not have an impact on the survival [41,42].…”

Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis

“…Finally, 37 studies were included for evidencemapping of the trend of 'planned' and 'actual' dose of FOLFIRINOX, and 27 studies were included in the meta-analysis for comparison of clinical outcome according to planned dose of FOLFIRINOX. 3,[6][7][8] Description of the included studies Of the 37 studies, 11 and 26 were prospective studies 3,[16][17][18][19][20][21][22][23][24][25] and retrospective studies, [6][7][8] respectively (Table 1). The country included the most was Japan (N = 10) followed by Korea (N = 6), USA (N = 5), and China (N = 5).…”