title: Defining Eligibility of FOLFIRINOX for First-Line Metastatic Pancreatic Adenocarcinoma (MPC) in the Province of British Columbia: A Population-based Retrospective Study.
abstract: BACKGROUND
  FOLFIRINOX is a first-line treatment option for patients with metastatic pancreatic cancer (MPC) and is associated with improved survival yet significantly more toxicities than standard gemcitabine. Our aim was to determine the proportion of patients with MPC who would be eligible for FOLFIRINOX based upon the pivotal ACCORD study criteria.
  
  
  METHODS
  Patients with confirmed MPC at the time of referral to the BC Cancer Agency between 2004 and 2007 were identified from the Gastrointestinal Cancers Outcomes Unit Database (GICOU). Proportion of patients that met the ACCORD study eligibility criteria was determined by chart review. Criteria for FOLFIRINOX exclusion were assessed using descriptive statistics.
  
  
  RESULTS
  A total of 100 consecutive patients with complete chart records and MPC were identified. Fifty-two (52%) were male and the median age was 68 years (range, 42 to 98 y). The most common sites of metastases were liver (63%) and peritoneum (22%). Only 26 patients fulfilled the ACCORD study eligibility criteria. The most common reasons for FOLIFIRINOX exclusion per ACCORD were poor Eastern Cooperative Oncology Group score of ≥2 (64%), age of 76 years or greater (22%), elevated bilirubin (22%), and inadequate renal function (6%).
  
  
  CONCLUSIONS
  Despite the proven survival benefit of FOLFIRINOX, only approximately one quarter of patients in the real-world setting with MPC would have been considered eligible for such therapy based upon the ACCORD eligibility criteria. Careful patient selection and more tolerable therapies are required.
authors.affiliation: Divison of Medical Oncology, Cross Cancer Institute, Edmonton, AB.
authors.forename: Maria Yi
authors.initials: MY
authors.lastname: Ho
authors.affiliation: Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Hagen F
authors.initials: HF
authors.lastname: Kennecke
authors.affiliation: Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Renouf
authors.affiliation: Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Winson Y
authors.initials: WY
authors.lastname: Cheung
authors.affiliation: Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Lim
authors.affiliation: Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Sharlene
authors.initials: S
authors.lastname: Gill
mesh_terms: D000203:Activities of Daily Living; D000230:Adenocarcinoma / Q000188:drug therapy* / Q000453:epidemiology / Q000556:secondary; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001955:British Columbia; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D004608:Eligibility Determination; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D006932:Hyperbilirubinemia / Q000453:epidemiology; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000556:secondary; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin