title: FOLFIRINOX for locally advanced or metastatic pancreatic ductal adenocarcinoma: the Royal Marsden experience.
abstract: BACKGROUND
  Pancreatic ductal adenocarcinoma (PDA) has a very poor prognosis. Treatment with FOLFIRINOX has been shown to improve outcomes, but can be associated with significant toxicity.
  
  
  METHODS
  A retrospective review was performed of all patients with locally advanced or metastatic PDA treated with FOLFIRINOX at the Royal Marsden between November 2010 and November 2013. Efficacy, tolerability, and potential prognostic factors were evaluated.
  
  
  RESULTS
  Twenty-seven patients with metastatic PDA and 22 patients with locally advanced PDA were treated with FOLFIRINOX. Patients received a median of 9 cycles (range, 1-26) of FOLFIRINOX. The overall response rate was 41% (20 patients), and a further 17 patients (35%) had stable disease. Thirty-five patients (71%) received FOLFIRINOX in the first-line setting, with a median progression-free survival and overall survival, respectively, of 12.9 months and 18.4 months for patients with locally advanced disease; and 8.4 months and 12.2 months for patients with metastatic disease. The most frequently occurring Grade 3/4 toxicities were neutropenia (29%), fatigue (18%), febrile neutropenia (14%), thromboembolism (12%), and thrombocytopenia (10%). In a univariate analysis, reduction in CA 19-9 of >50% (P < .001), normalization of CA19-9 (P < .001), surgery after FOLFIRINOX (P = .004), and use of prophylactic pegfilgrastim (P = .005) were prognostic for overall survival.
  
  
  CONCLUSIONS
  The efficacy and tolerability of FOLFIRINOX for PDA at our institution is similar to that reported in clinical trials. Careful selection of patients and monitoring of response (according to CA19-9) and toxicities can help maximize advantage in this patient population.
authors.affiliation: Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Surrey, United Kingdom.
authors.forename: Sing Yu
authors.initials: SY
authors.lastname: Moorcraft
authors.affiliation: Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Surrey, United Kingdom.
authors.forename: Khurum
authors.initials: K
authors.lastname: Khan
authors.affiliation: Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Surrey, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Peckitt
authors.affiliation: Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Surrey, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Watkins
authors.affiliation: Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Surrey, United Kingdom.
authors.forename: Sheela
authors.initials: S
authors.lastname: Rao
authors.affiliation: Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Surrey, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Surrey, United Kingdom. Electronic address: ian.chau@rmh.nhs.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Chau
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: CA 19-9; Granulocyte-colony stimulating factor; Nab-paclitaxel; Response; Toxicity