FOLFIRINOX safe, effective in older adults with advanced pancreatic cancer

The combination therapy of 5-fluorouracil, irinotecan, leucovorin, and oxaliplatin (FOLFIRINOX) improves response and overall survival (OS) in older adults with advanced pancreatic cancer (APC), a recent study has shown.

In addition, “FOLFIRINOX has a manageable safety profile in this population and should be considered in fit older adults with APC,” the investigators said.

Using the Manitoba Cancer Registry, the investigators identified patients diagnosed with APC from 2011 to 2016. They compared patient and treatment characteristics, toxicity, and outcomes of patients aged ≥65 years treated with palliative chemotherapy by treatment regimen.

The Kaplan-Meier method was used to assess OS, while Cox regression was employed to identify the independent predictors of OS.

Eighty-seven adult patients with APC were treated with palliative chemotherapy, of whom 52 (59.7 percent, median age 69 years) received FOLFIRINOX, 21 (24.1 percent, median age 75 years) received nab-paclitaxel and gemcitabine, and 14 (16.1 percent, median age 73 years) received gemcitabine.

Nonhaematologic toxicity increased with FOLFIRINOX (p<0.001), particularly neuropathy (p=0.008), fatigue (p<0.001), and nausea/vomiting (p=0.008). FOLFIRINOX also led to improvements in radiologic response (p=0.05) and OS (p=0.035).

The following factors independently predicted survival in this population: performance status, chemotherapy regimen, and baseline carbohydrate antigen 19-9 level.

“Randomized trials demonstrate improved OS with combination chemotherapy FOLFIRINOX or nab-paclitaxel and gemcitabine compared with gemcitabine alone, but with increased toxicity,” the investigators said. “Older adults are at increased risk of side effects from chemotherapy.”