Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort

Author(s):
Zweeden, A.A. van; Geest, L.G.M. van der; Pijnappel, E.N.; Vos-Geelen, J. de; Hooft, J.E. van (0000-0002-4424-0079); Stommel, M.W.J.; Wit, G.F. de; Verheul, H.M.W.; Laarhoven, H.W.M. van; Vliet, H.J. van der; Wilmink, J.W.; Dutch Pancreatic Canc Grp
Published
2025
Publication type
Article / Letter to editor

Abstract

Background

FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) can improve the prognosis of advanced pancreatic ductal adenocarcinoma (PDAC). Upon progression after a therapy-free interval it is not uncommon to reintroduce FOLFIRINOX, depending on the response and progression free interval after first-line FOLFIRINOX. The aim of this study is to provide an overview of the use and effectiveness of FOLFIRINOX reintroduction in daily practice.

Patients and methods Patients with locally advanced and metastatic PDAC, diagnosed between 2015 and 2018, who started systemic treatment with palliative intent were selected from the Netherlands Cancer Registry (NCR). Overall and progression free survival (OS, PFS) were evaluated using Kaplan-Meier curves with log-rank tests. Results In this cohort of 2092 patients, most were treated with first-line FOLFIRINOX (1381; 66 %). The median OS was 9.0 months. A total of 388 patients (28 %) received subsequent systemic therapy after first-line FOLFIRNOX; 119 (30.7 %) patients were re-treated with FOLFIRINOX after a minimum of 3 months treatment interruption while 269 patients received other therapies, mostly gemcitabine/nab-paclitaxel or gemcitabine monotherapy. The median therapy-free interval between first-line FOLFIRINOX and FOLFIRINOX reintroduction was 7.0 months (p25-p75: 4,6–10,6). Patients underwent a median of 5 cycles (range: 1–32) during initial treatment and 5 cycles (range: 1–28) during FOLFIRINOX reintroduction. Median OS after FOLFIRINOX reintroduction was 23.4 months, and median progression-free survival was 6.8 months. Conclusion Reintroduction of FOLFIRINOX after at least 3 months therapy-free interval is used in daily practice and seems a reasonable treatment option based on a favorable OS and PFS in a small subset of patients.

Pancreatic cancerFOLFIRINOXRetrospective real world dataCohort studyDrug holiday
Date issued
2025-05-01
Language
English
Publisher
Elsevier
Is part of
Pancreatology (2025), Vol. 25, no. 3, p. 433-439
hdl
1887/4266735
doi
10.1016/j.pan.2025.03.011
URL
https://www.sciencedirect.com/science/article/pii/S142439032500064X?via%3Dihub