FLORFIRINOX For Metastatic Pancreatic Cancer

There hasn’t been much good news in the treatment of metastatic pancreatic cancer.  Simply put, existing chemotherapies just haven’t been effective enough.  New therapies and new approaches are sorely needed. A recent report in the New England Journal of Medicine is therefore very exciting.  The May 12, 2011 New England Journal of Medicine (N Engl J Med 364;19) contains a report by Thierry Conroy, M.D. and colleagues from the Groupe Tumeurs Digestives of Unicancer and the PRODIGE Intergroup  in France describing the results of an exciting clinical trial of the drug combination known as “FOLFIRINOX.”  In this large study 342 patients with metastatic pancreatic cancer were randomized to receive either FOLFIRINOX or gemcitabine (Gemzar).  Six months of chemotherapy were recommended in both groups in patients who had a response, and the primary end point of the study was overall survival.  The patients who received FOLFIRINOX did significantly better than the patients who received gemcitibine.  The median overall survival was 11.1 months in the group treated with FOLFIRINOX as compared with 6.8 months in the patients treated with gemcitabine, and the median progression-free survival was 6.4 months in the FOLFIRINOX group and 3.3 months in the gemcitabine group.  31% of the patients who received FOLFIRINOX had an objective clinical response versus 9.4% in the gemcitabine group.  FOLFIRINOX treatment is not without its draw backs as the FLORFIRINOX group did have some side effects of therapy, and some of these were serious.  45% of the patients treated with FOLFIRINOX developed neutropenia (a low white blood cell count), and smaller percentages developed serious diarrhea (13%) and neuropathy (9%, nerve injury).  FOLFIRINOX isn’t for all patients with metastatic pancreatic cancer as these side effects are not trivial and may not be tolerated by some patients.

This important study demonstrates exciting progress in the treatment of pancreatic cancer.  Our hope is that these promising initial results with FLORFIRINOX will be validated in follow-up studies, and that other more potent agents with fewer side effects will be developed.  Until then, it looks like FLORFIRINOX will be another agent in the pancreatic cancer oncologist’s armamentarium.

For more information on the multidisciplinary treatment of patients with pancreatic cancer at johns Hopkins visit:  http://pathology.jhu.edu/pancreas/

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