A105: FOLFIRINOX for the treatment of advanced pancreatic cancer: UK West Midlands experience
1University Hospital Birmingham, Birmingham, West Midlands, UK,2University Hospital Coventry and Warwickshire, Coventry, West Midlands, UK,3George Eliot Hospital NHS Trust, Nuneaton, UK,4South Warwickshire NHS Foundation Trust, Warwickshire, UK,5University Hospitals of North Midlands NHS Trust, Stafford, UK,6Worcestershire Royal Hospital, Worcester, UK,7Heart of England NHS Foundation Trust, Birmingham, West Midlands, UK
PRODIGE 4/ACCORD 11 trial demonstrated that FOLFIRINOX significantly improved response rates and survival in patients with metastatic pancreatic cancer, compared to gemcitabine. However this regimen is associated with significant toxicity. We have analysed the safety, tolerability and efficacy of FOLFIRINOX given outside a clinical trial setting.
A retrospective analysis was conducted on patients treated with FOLFIRINOX for advanced pancreatic cancer between July 2012 and July 2014, within the West Midlands region in the UK. Data was collected on baseline demographics, disease stage, toxicity and response to chemotherapy.
A total of 60 patients were identified (28 locally advanced, 32 metastatic). Median age was 59 (range 34-74). The primary tumour was located in the head of the pancreas in 68% of patients and 38% of patients had a biliary stent. All patients had an ECOG performance status of 0 or 1 (45% and 55% respectively), and had received no prior chemotherapy for advanced pancreatic cancer. FOLFIRINOX was commenced at reduced doses in 79% patients, subsequent dose reductions were required in 81% patients. Median number of FOLFIRINOX cycles was 6 (range 1-14) but 33% of patients currently remain on treatment. Hospital admissions were required in 58% of patients but only 22% for neutropenic sepsis. FOLFIRINOX was discontinued in 30% of patients due to toxicity. There were no treatment related deaths. Of 40 patients eligible for response assessment, 38% achieved a partial response and 40% achieved stable disease. Two patients with locally advanced pancreatic cancer became suitable for curative surgical resection following chemotherapy. Median OS for patients with metastatic disease was 12 months and median OS for locally advanced disease patients has not been reached.
FOLFIRINOX can be safely delivered in a real world setting. Even with reduced doses, the response rates and survival outcomes are comparable with the results from the PRODIGE 4/ACCORD 11 trial.