FOLFIRINOX - a new paradigm in the treatment of pancreatic cancer

Expert Rev Anticancer Ther. 2014 Oct;14(10):1115-25. doi: 10.1586/14737140.2014.957188. Epub 2014 Sep 10.

Abstract

Treatment of metastatic and locally advanced pancreatic cancer has made slow progress during the last decade. Single agent gemcitabine or in combination with capecitabine or erlotinib remained the preferred systemic treatment options until 2010 when the ACCORD study demonstrated significantly improved outcomes achieved with FOFIRINOX compared with gemcitabine monotherapy. Since 2010, use of FOLFIRINOX has increased both in metastatic and locally advanced cancer. Despite its gaining popularity among oncologists, unanswered questions remain. Do the often necessary dose modifications affect its efficacy? Are the toxicities manageable and how applicable are the results of the ACCORD study in the general population of patients with newly diagnosed pancreatic cancer? In the present manuscript, we review the published literature regarding the use of FOLFIRINOX, the challenges associated with its use and how it will be optimally incorporated into the management of patients with different stages of pancreatic cancer and ultimately, in a more biomarker-driven pathway algorithm.

Keywords: chemoradiotherapy; chemotherapy; clinical trials; genomics; pancreas cancer.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Animals
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Biomarkers, Tumor / metabolism
  • Camptothecin / administration & dosage
  • Camptothecin / analogs & derivatives
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Deoxycytidine / therapeutic use
  • Fluorouracil / administration & dosage
  • Gemcitabine
  • Humans
  • Irinotecan
  • Leucovorin / administration & dosage
  • Organoplatinum Compounds / administration & dosage
  • Oxaliplatin
  • Pancreatic Neoplasms / drug therapy*
  • Pancreatic Neoplasms / pathology
  • Treatment Outcome

Substances

  • Biomarkers, Tumor
  • Organoplatinum Compounds
  • Oxaliplatin
  • Deoxycytidine
  • Irinotecan
  • Leucovorin
  • Fluorouracil
  • Camptothecin
  • Gemcitabine