P0218 Metastatic pancreatic carcinoma and experience with FOLFIRINOX: A cross-sectional analysis from a developing country

Abstract

Background Pancreatic cancer is the fourth leading cause of cancer-related deaths, with median survival ranging from 3 to 6 months for metastatic disease. Palliative chemotherapy has been the backbone of treatment in advanced stage disease and has evolved over time. Data pertaining to the disease is scarce from our part of the world, where treatment poses a significant challenge due to lack of resources. Methods Retrospective chart review was performed for all patients presenting with stage IV pancreatic carcinoma at a tertiary care hospital in Karachi, Pakistan between January 2008 and December 2012. Data was collected using a pre-designed, coded questionnaire that covered patient characteristics, treatment, and outcome. Findings One hundred and one patients were eligible. Mean age was 56.7 ± 12.8 years, male to female ratio was 2:1, and most patients had a good performance status. More than half of the tumours were located in the head (57%, n = 58) and almost all were adenocarcinomas (95%, n = 96). 58% (n = 59) received first-line chemotherapy, of which 49% (n = 29) received gemcitabine-based therapy and 39% (n = 23) received fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX). Median progression-free survival for gemcitabine-based treatment was 2.9 months (interquartile range [IQR] 1.6–5.6), compared with 7.3 months (IQR 4.5–9.2) for FOLFIRINOX (p = 0.02). Median overall survival was 4.9 months (IQR 2.3–9.5) for first-line gemcitabine-based treatment and 10.5 months (IQR 7.0–13.2) for first-line FOLFIRINOX therapy (p = 0.002). Patients who received FOLFIRINOX had better survival across all subgroups. Inpatient admissions and dose reductions were more frequent with FOLFIRINOX, but the difference between the two regimens was not statistically significant. FOLFIRINOX was successfully administered as outpatient therapy for some patients. Interpretation FOLFIRINOX remains a suitable first-line option in patients with metastatic pancreatic cancer and good performance status, even in a resource-poor country where diagnostic and supportive-care facilities may be suboptimum and cost is a limitation.