Folfirinox prolongs survival in individuals with resected pancreatic ductal adenocarcinoma: Study

493 patients in total were randomly assigned in 1:1 ratio to receive modified FOLFIRINOX (oxaliplatin, 85 mg/m2 of body surface area; irinotecan, 150–180 mg/m2; leucovorin, 400 mg/m2; and fluorouracil, 2400 mg/m2, every 2 weeks) or gemcitabine (1000 mg/m2, days 1, 8, and 15, every 4 weeks) as adjuvant therapy for 24 weeks. Illness-free survival served as the main end point. Secondary outcomes included overall survival, survival without metastases, and survival for the particular cancer. It was assessed what factors might predict overall survival.

Findings of the trial:

In patients treated with modified FOLFIRINOX compared to gemcitabine

• median disease-free survival was 21.4 months vs 12.8 months (hazard ratio [HR], 0.66).
• The 5-year disease-free survival was 26.1% vs 19.0%.
• median overall survival was 53.5 months vs 35.5 months (HR, 0.68).
• The 5-year overall survival was 43.2% vs 31.4%.
• median metastasis-free survival was 29.4 months vs 17.7 months (HR, 0.64)
• median cancer-specific survival was 54.7 months vs 36.3 months (95% CI, 30.5–43.9) (HR, 0.65).
• Modified FOLFIRINOX, age, tumor grade, tumor staging, and larger-volume centers were all found to be significant positive predictive variables for overall survival by multivariable analysis. A negative prognostic factor was a shorter relapse latency.

After PDAC resection, modified FOLFIRINOX is advised as part of the adjuvant treatment plan, the authors concluded.

REFERENCE

Conroy T, Castan F, Lopez A, et al. Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial. JAMA Oncol. Published online September 01, 2022. doi:10.1001/jamaoncol.2022.3829