P-206 - Expanded analysis of mFOLFIRINOX as second-line chemotherapy in pancreatic adenocarcinoma

Abstract

Introduction: Folfirinox is a highly effective first-line chemotherapy regimen in patients with good performance status. The landscape in second-line therapy is, however, less clear with many oncologists feeling uncomfortable using Folfirinox based upon toxicity data from the original ACCORD study. Our aim is to assess our single institution’s experience in the use of the more tolerable mFOLFIRINOX in the 2nd line setting. Since our previous publication, we have gained additional experience with more patients receiving this regimen as second-line therapy. At the time of writing, we have used Folfirinox in 40 patients up to age 85 years. Methods: 40 patients who had previously received gemcitabine-based chemotherapy for pancreatic adenocarcinoma were identified from our database. The records were then examined to determine treatment outcomes and toxicities together with dose intensities delivered. Results: Out of 40 patients with an age range of 27 to 85, 14 were aged over 70. 2 patients had received single agent gemcitabine and 38 gemcitabine in combination with nab-paclitaxel. Dose intensity was 65% for oxaliplatin, 68% for irinotecan, 18% for bolus 5-FU and 68% for infusional 5FU. A 10% grade 3 toxicity rate was observed with modifications mainly for neuropathy from oxaliplatin. Significantly, we noted that overall survival in this group ranged from 5-67 months (median 23 months for locally advanced/15 months for metastatic). More than half of the patients received a minimum of 6 cycles, with 20 patients receiving greater than 6 cycles of treatment and 8 patients more than 12 cycles. One patient has received 70 cycles with excellent control of ascites and peritoneal disease. Conclusion: Our single institution experience continues to demonstrate the safety, tolerability and efficacy of mFolfirinox as a second-line therapy after gemcitabine failure. A formal study using mFOLFIRINOX as the interventional arm would be extremely useful in determining whether this approach shows merit in a more rigorous scientific setting.