In patients with localized pancreatic ductal adenocarcinoma, fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) may have advantages over gemcitabine plus nanoparticle albumin-bound paclitaxel (GA), according to an observational study by Texas-based researchers. As Dr. Giampaolo Perri told Reuters Health by email, "After evaluating different metrics of response to therapy and surgical and survival outcomes, FOLFIRINOX appeared to be associated with a higher rate of radiographic response and subsequent pancreatectomy, but the overall survival associated with the two regimens was similar." In an online paper in JAMA Surgery, Dr. Perri and colleagues at The University of Texas MD Anderson Cancer Center, Houston, report on their review of data on 485 previously untreated patients who, between 2010 and 2017, received at least 3 cycles of first-line chemotherapy with FOLFIRINOX or GA. Patients given FOLFIRINOX were generally younger, with a median age at diagnosis of 61 years compared to 71 years in those given GA. They also had better performance status as indicated by the Eastern Cooperative Oncology Group scale but more invasive tumors than the GA group. After propensity matching to allow for those and other factors in a total of 280 patients, many objective serologic and radiographic metrics of response did not differ between groups. However, after FOLFIRINOX, Response Evaluation Criteria in Solid Tumors partial response was more common (19% versus 6%) and pancreatectomy was performed more often. Nevertheless, the overall median survival of patients treated with FOLFIRINOX (21 months) was similar to that in those given GA (20 months). Thus Dr. Perri concluded, "Despite certain advantages that may be associated with FOLFIRINOX in this setting, the choices between these regimens should always take into account their known toxicity profiles and patient's clinical status." In an accompanying editorial, Dr. Joe Hines of the David Geffen School of Medicine at University of California, Los Angeles, notes that although this study shows a potential benefit of treatment associated with FOLFIRINOX, larger and prospective trials are required. However, he told Reuters Health by email, "Chemotherapy before surgery for pancreatic cancer will become the recommended approach soon, and this study supports this concept. Once ongoing trials are completed, we should have enough evidence to treat all patients with chemotherapy first." —David Douglas Source
