FOLFIRINOX is a trial of a combination of chemotherapy drugs fluorouracil [5-FU], leucovorin, irinotecan and oxaliplatin or standard single-drug treatment, gemcitabine. Patients with metastatic pancreatic cancer are eligible.
Patients in the FOLFIRINOX arm receive oxaliplatin (85 mg/m2 over two hours), leucovorin (400 mg/m2 over two hours), irinotecan (180 mg/m2 over 90 minutes), and 5-FU(400 mg/m2 bolus then 2,400 mg/m2 over 46 hours), all on day 1, and then repeated every two weeks. Patients in the control arm receive gemcitabine (1,000 mg/m2 IV over 30 minutes weekly for seven of eight weeks, one week rest, and then weekly for three of four weeks). Recent results from a french study have shown this combination is promising.
The study’s authors1, presenting at ASCO 2010, reported 48% of patients on FOLFIRINOX were alive after 1 year compared to 20% on the gemcitabine arm and, for the first time in a study involving patients with metastatic pancreatic cancer, a median overall survival of 11.1 months was obtained on the FOLFIRINOX arm.
FOLFIRINOX is not approved by either NICE (National Institute of Clinical Excellence) in England and Wales nor the SMC (Scottish Medicines Consortium) so is not available as standard treatment for pancreatic cancer.
Some centres in the UK will offer FOLFIRINOX to advanced pancreatic cancer patients if they get approval from the PCT (Primary Care Trust)
However, it is much more toxic and side effects can be greater than the standard therapy – so it is not suitable for all patients.
To find out if you are eligible for any current clinical trials in the UK, speak to your oncologist or click here to see a list of pancreatic cancer clinical trials
Typical FOLFIRINOX treatment
The treatment will usually consist of the following:
- Day 1 Oxaliplatin infusion (by drip) over 2 hours, followed byIrinotecan and folinic acid infusion over 2 hours, followed by Fluorouracil as a fast infusion over 15 minutes, followed by Fluorouracil as a slow infusion over 46 hours (at home) via a pump through a central venous catheter.
- Day 3 District nurse home visit to take pump off and flush line.
- Day 15 Repeat of day 1 and start of next cycle of treatment
This treatment is repeated every 2 weeks for a total of 6 to 12 cycles.
For information on possible FOLFIRINOX side effects, consult your medical team.
- Conroy et al., (2010) Randomized phase III trial comparing FOLFIRINOX (F: 5FU/leucovorin [LV], irinotecan [I], and oxaliplatin [O]) versus gemcitabine (G) as first-line treatment for metastatic pancreatic adenocarcinoma (MPA): Preplanned interim analysis results of the PRODIGE 4/ACCORD 11 trial. J. Clin Oncol 28: 303s ↩
The information provided in this site, or through links to other websites, is not a substitute for medical or professional care and should not be relied upon as such. Read our disclaimer.