Combination chemotherapy with FOLFIRINOX (oxaliplatin, irinotecan, fluorouracil and leucovorin) has been shown to be effective in pancreatic adenocarcinoma. Our aim was to conduct a retrospective review of all patients treated with FOLFIRINOX regime for pancreatic adenocarcinoma at St. John of God Hospital, Subiaco, Perth, Western Australia.
All patients receiving FOLFIRINOX chemotherapy at St. John of God Hospital Subiaco from August 2011 to April 2014 were identified from case files. Tolerability, response and dose adjustments were determined from medical records, laboratory results and radiological assessments.
Twenty-four patients were identified, with a median age of 58 (27-84), including 7 over 70 years old. All patients had received first line chemotherapy with gemcitabine +/- abraxane. In total 152 cycles were administered, with a median number of 7 cycles (1-33) per patient. All patients received dose attenuation (17 in the first cycle). Dose density acheived was 71% of intended for oxaliplatin, 66% irinotecan, 45% 5-FU, which is similar to that reported in studies by Conroy et al (N Engl J Med 364: 1817-1825, 2011) and the recent study from Yale (Gunturu KS et al, Med Oncol (2013) 30:361. The over 70 year subgroup achieved similar dose density. There was one case of febrile neutropenia, one case of Grade 3 sensory neuropathy, one case of Grade 3 hepatitis. Disease control rate was 55% (57% in the over seventy subgroup), which compares favorably to that reported by Conroy and Gunturu (32% and 47% respectively).
In our experience, FOLFIRINOX was well tolerated as a second line option for advanced pancreatic adenocarcinoma, regardless of age. Prior studies have excluded elderly patients because of fears of toxicity, however our results demonstrate similar dose density achieved and response rates in an over-70 years cohort compared to younger subjects given full dose therapy. FOLFIRINOX can be safely administered to elderly patients with appropriate dose reductions and subsequent dose escalation.