Second-line treatment with modified FOLFIRINOX in patients with pancreatic adenocarcinoma who have failed first-line treatment with gemcitabine and nab-paclitaxel

As new evidence emerges, gemcitabine with nab-paclitaxel is becoming increasingly more popular as first-line chemotherapy for pancreatic cancer due to its efficacy over single agent gemcitabine and it’s favourable toxicity profile over FOLFIRINOX. A systematic review and meta-analysis carried out by Lu et Al evaluating FOLFIRINOX as a second-line chemotherapy for pancreatic cancer patients that have failed gemcitabine-based chemotherapy showed a survival benefit with FOLFIRINOX compared with other second-line regimens across all six studies. To combat the adverse events associated with FOLFIRNOX it has become commonplace to use modified dosing. In a multicenter phase II study of modified FOLFIRINOX (m-FOLFIRINOX) in metastatic and locally advanced pancreatic cancer, decreased adverse events were observed with no reduction in efficacy. As a single centre in Western Australia, we have previously reported our experience of 68 patients who were treated with second-line m-FOLFIRINOX, this is an update on the previously reported data.

We conducted a retrospective analysis using an electronic database of patients with locally advanced or metastatic pancreatic cancer who received second-line m-FOLFIRINOX between December 2012 and January 2023. All patients were deemed to have an ECOG performance status of 2 or less. Overall survival (OS) was estimated via the Kaplan-Meier method.

There were 128 patients identified in our analysis, with 59% of the patients having metastatic disease. The median age of patients was 65 (range, 26 – 83). Dose intensity of m-FOLFIRINOX was as follows: 65% for oxaliplatin, 68% for irinotecan, 18% for bolus 5-fluorouracil (5-FU) and 68% for infusional 5-FU. The median OS of all patients was 37.0 months (95% CI, 27.0 – 49.0). The median OS of the locally advanced and metastatic pancreatic adenocarcinoma from diagnosis was 50.0 months (95% CI, 45.0 – 71.0) and 23.0 months (95% CI, 21.0 – 37.0), respectively.

As demonstrated by a retrospective analysis of 128 patients in a single centre in WA, modified FOLFIRINOX is an effective second-line therapy for the treatment of locally advanced and metastatic pancreatic cancer who have failed first-line treatment with gemcitabine and nab-paclitaxel.

The authors.

Has not received any funding.

All authors have declared no conflicts of interest.