title: Safety and efficacy of FOLFIRINOX in elderly patients with metastatic or locally advanced pancreatic adenocarcinoma: A retrospective analysis.
abstract: BACKGROUND
  FOLFIRINOX is a polychemotherapy regimen currently used to treat inoperable pancreatic cancer in patients with a good performance status (PS). FOLFIRINOX lengthens overall survival time (OS), but no specific data are available in elderly patients.
  
  
  METHODS
  All cases of inoperable pancreatic adenocarcinoma in patients over 70 years old treated with FOLFIRINOX were retrospectively reviewed between 2008 and 2015 in five institutions in France. The primary objective was to evaluate the safety and efficacy of FOLFIRINOX in the elderly.
  
  
  RESULTS
  Forty-two patients with a median age of 73 years (range: 70-79) and a median PS of 1 (range: 0-2) were included. 88% of patients treated with FOLFIRINOX were enrolled between 2012 and 2015. 24 patients (57%) needed a primary dose reduction but this did not impact OS (median OS 11.7 months (6.9-16.4) compared to 16.6 months (0.37-32.8) without dose reduction, p = 0.69). Twelve patients (29%) experienced grade 3 toxicity. Sensory neuropathy occurred most often (56%). Primary prophylaxis with granulocyte colony stimulating factor (GCSF) was administered to 14 patients (33%). One treatment-related death occurred (septic shock), although this patient had not had primary prophylaxis with GCSF. Median follow-up was 86 months. Median OS was 11.6 months (95%CI: 8.9-14.3).
  
  
  CONCLUSIONS
  Median OS observed in the elderly was similar to OS previously reported in younger patients in the ACCORD 11 trial. FOLFIRINOX is effective in selected, fit elderly patients but with greater grade 3 neurotoxicity. Primary dose reduction and primary GCSF prophylaxis may control tolerance.
authors.affiliation: Department of Medical Oncology, Hospital Huriez, University Lille Nord de France, Lille, France; Department of Digestive-Oncology, Oscar Lambret Cancer Center, Lille, France. Electronic address: capucine.baldini@chru-lille.fr.
authors.forename: C
authors.initials: C
authors.lastname: Baldini
authors.affiliation: Department of Medical Oncology, Hospital Huriez, University Lille Nord de France, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Escande
authors.affiliation: Department of Medical Oncology, University Hospital, Reims, France.
authors.forename: O
authors.initials: O
authors.lastname: Bouché
authors.affiliation: Department of Digestive-Oncology, Oscar Lambret Cancer Center, Lille, France.
authors.forename: F
authors.initials: F
authors.lastname: El Hajbi
authors.affiliation: Department of Medical Oncology, University Hospital, Reims, France.
authors.forename: J
authors.initials: J
authors.lastname: Volet
authors.affiliation: Department of Medical Oncology, Boulogne-sur-mer Hospital, France.
authors.forename: V
authors.initials: V
authors.lastname: Bourgeois
authors.affiliation: Department of Medical Oncology, Valenciennes Hospital, France.
authors.forename: T
authors.initials: T
authors.lastname: Renaut Vantroys
authors.affiliation: Department of Medical Oncology, Hospital Huriez, University Lille Nord de France, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Ploquin
authors.affiliation: Department of Medical Oncology, Hospital Huriez, University Lille Nord de France, Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Desauw
authors.affiliation: Department of Medical Oncology, Hospital Huriez, University Lille Nord de France, Lille, France.
authors.forename: M
authors.initials: M
authors.lastname: Hebbar
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: Elderly; FOLFIRINOX; Pancreatic cancer