FOLFIRINOX has become the standard of care for metastatic pancreatic cancer. It has promising
results and has improved survival for pancreatic cancer. FOLFIRINOX is a 4-drug treatment regimen, consisting of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin. It’s producing the greatest prolonging of survival ever seen in patients with metastatic pancreatic cancer. Patients
who have received the regimen have lived approximately four months longer than patients who did not receive the regimen.
In 2011, Conroy and colleagues compared gemcitabine to FOLFIRINOX in healthy patients with metastatic cancer. 342 patients were in this study reported in the New England Journal of Medicine. FOLFIRINOX improved survival, as well as, quality of life for pancreatic cancer patients.
“Clearly, these are the best results we’ve seen to date for advanced pancreatic cancer in terms of response rate and overall outcome,” stated Al Benson, MD, of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
Results from this drug trial was unexpected. For the last few decades, numerous chemotherapy drugs have been tested alone and in various combinations in patients with pancreatic cancer, almost always with little or no impact on progression or survival.
“Clinicians and patients still have to weigh the risks versus the benefits,” states Jack Welch, MD, PhD, of the National Cancer Institute, Division of Cancer Treatment and Diagnosis, “But the benefit of the FOLFIRINOX regimen is really hard to overstate in terms of what’s been accomplished in pancreatic cancer to date.”
The most serious side effects associated with the FOLFIRINOX regimen include neutropenia – a low white blood cell count, making the patient more vulnerable to threatening infections. The regimen can also cause neuropathy (nerve damage) and gastrointestinal problems.
Researchers report that they may have found a way to identify which patients could respond well to FOLFIRINOX. The presence of an enzyme, carboxylesterase 2 (CES2), if found in tumor tissue, is predictive of a favorable response. Researchers continue to investigate the benefit of FOLFIRINOX including in early stage pancreatic cancer.