Use of FOLFIRINOX chemotherapy in an Australasian population of pancreatic cancer

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Pancreatic Cancer
Presenter Azim Jalali
Citation Annals of Oncology (2018) 29 (suppl_9): ix46-ix66. 10.1093/annonc/mdy432
Authors A. Jalali1, M. Lee1, C. Semira1, S. Banks1, H. Wong1, S. Ananda1, L. Lipton1, J.D. Shapiro2, P. Cooray3, K. Clarke4, M. Burge5, R. Wong6, J.A. Shapiro7, S. McLachlan8, M. Harris9, D. Croagh9, N. Tebbutt10, P. Gibbs1, B. Lee1
  • 1Systems Biology And Personalised Medicine, Walter and Eliza Hall Institute of Medical Research, 3052 - Parkville/AU
  • 2Department Of Medical Oncology, Cabrini Health, 3144 - Malvern/AU
  • 3Medical Oncology, Knox Private Hospital, Knox/AU
  • 4Medicine, Cancer And Community, Capital and Coast District Health Board - Wellington Regional Hospital, 6242 - Wellington/NZ
  • 5Medical Oncology, Royal Brisbane and Women's Hospital, 4006 - Brisbane/AU
  • 6Medical Oncology, Eastern Health, Box Hill/AU
  • 7Monash School Of Medicine, Monash University, Melbourne/AU
  • 8Medical Oncology, St Vincent’s Hospital, Fitzroy/AU
  • 9Medical Oncology, Monash Health, Clayton/AU
  • 10Medical Oncology, Austin Hospital, Heidelberg/AU

Abstract

Background

Phase 3 trials have identified FOLFIRINOX (Oxaliplatin, Irinotecan, Fluorouracil and Leucovorin) as the most active chemotherapy regimen in metastatic pancreatic ductal adenocarcinoma (PDAC); however, this regimen is not always selected for use by clinicians due to toxicity. It is unknown whether results from FOLFIRINOX in clinical practice in the Australasian population reflect that of the international trials.

Methods

An international multi-centre retrospective study of consecutive patients with PDAC was performed using the Australasian Pancreatic cancer registry (PURPLE: Pancreatic cancer: Understanding Routine Practice and Lifting End Results). The database was queried to identify patients receiving FOLFIRINOX. Baseline characteristics including resectability of disease as assessed by the centre, treatment details, toxicity and outcome data were analysed. Efficacy measures included objective response (OR), overall survival (OS) and progression-free (progression/recurrence) survival (PFS).

Results

From a total of 774 patients, 55 (7%) received FOLFIRINOX. Median age of FOLFIRINOX-treated patients was 57 yrs (range: 41–80). The ECOG performance score was 0-1 for 96%. FOLFIRINOX was administered for borderline resectable disease (BRD) in 28 cases and for metastatic disease (MD) in 16; the median number of cycles were 6 (range 3-16) and 8 (range 3-12) in patients with BRD and MD respectively. 63% (15/24) of patients had OR, defined by CT following neoadjuvant FOLFIRINOX and 13 of 26 (50%) proceeded to curative intent surgery. Median OS and PFS were 34 and 15 months respectively in patients who had resection compared to 17 and 8 months in patients with unresectable or MD. The most common grade 3/4 toxicities were diarrhoea (25%) and myelosuppression (21%). 35% of patients received GCSF and 46% experienced at least one admission related to FOLFIRINOX toxicity.

Conclusions

Our study shows a modest overall uptake of FOLFIRINOX in routine practice. Where FOLFIRINOX is used in patients with BRD the conversion rate to resectable is promising. Survival outcomes in patients with MD approach that seen in clinical trials; however, adverse events are frequent, most notably diarrhoea and haematological toxicities.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Systems Biology and Personalised Medicine Division, Walter and Eliza Hall Institute of Medical Research, VIC, Australia.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.