P-0106 - The impact of FOLFIRINOX chemotherapy on the treatment pattern of patients with pancreas cancer seen at a tertiary referral centre in the UK

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Pancreatic Cancer
Presenter Neha Chopra
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors N. Chopra, R. Gillmore, F. El-Khouly, M. Julve, R. Goldstein, A. Mayer, C. Thirlwell, T. Meyer
  • Royal Free London NHS Trust, London/UK

Abstract

Introduction

Pancreatic cancer is the fourth cause of cancer death in the Western world. For nearly twenty years gemcitabine has been the standard treatment for patients with metastatic disease until in 2011 Conroy et al demonstrated a significant overall survival benefit (11.1 vs 6.4 months (p < 0.001)) with FOLFIRINOX chemotherapy compared with single agent gemcitabine. However patients in this study were of performance status 0 and 1 thus raising concerns as to how applicable this regimen would be to the management of patients with pancreas cancer.

Methods

We conducted a retrospective audit of all 120 pancreas cancer patients referred to a tertiary hepatobiliary centre from April 2011 until December 2013. Treatment records were available for all patients and data was obtained from electronic patient records and patient notes. All patients who received FOLFIRINOX were studied including locally advanced, recurrence post-surgery and metastatic pancreatic cancer. We collected data on the number of cycles received, the dose intensity of treatment, toxicity data as well as survival data.

Results

A total of 62 patients had metastatic disease at the time of presentation, 31 patients had locally advanced (LAPC) unresectable disease, 24 patients were referred for adjuvant chemotherapy of which 10 had recurrence treated with palliative intent and 3 patients had potentially resectable disease radiologically but were too unfit for any treatment. A total of 33 patients; 10 locally advanced (32% of total LAPC), 7 recurrence post-surgery (70% of this patient population) and 16 metastatic (26%) were treated with FOLFIRINOX chemotherapy. The median age was 60 years with a male to female split of 76% vs 24% respectively. Twenty-one percent of patients were performance status (PS) 0, 60% PS 1 and 12% PS 2, 6% were unavailable. All patients were given G-CSF with their FOLFIRINOX chemotherapy. The median number of cycles received by locally advanced cancer patients was 5 (3-12) and 29% of cycles were given at full dose. In the metastatic setting, which includes recurrence post-surgery patients, the median number of cycles was 6 (1-12). The median dose of oxaliplatin was 85%, irinotecan 86% and of 5-FU was 84%. The toxicity data demonstrated 18% of patients had neutropenia and 9% had neutropenic sepsis, none were fatal. There were no grade 4 non-haematological effects and no deaths from chemotherapy. The overall response rate was 45% and disease control rate 75%. Seventy percent of the locally advanced patients went on to have chemoradiotherapy; one patient had surgery with clear resection margins. The median overall survival of all patients was 10.8 months and a subgroup analysis revealed the survival for locally advanced and metastatic patients was 17.9 months and 10.8 months respectively.

Conclusion

Thirty three of 103 patients referred with either metastatic, locally advanced disease or disease recurrence post surgery were treated with FOLFIRINOX chemotherapy and thus this regimen that can be applied to a significant percentage of the pancreas cancer patient population. Furthermore, whilst FOLFIRINOX has been shown to be of value in metastatic pancreatic cancer it may also have a role in LAPC.