FOLFIRINOX

FOLFIRINOX is a chemotherapy regimen for treatment of advanced pancreatic cancer. It is made up of the following four drugs:

• FOL – folinic acid (leucovorin), a vitamin B derivative that modulates/potentiates/reduces the side effects of fluorouracil;
• F – fluorouracil (5-FU), a pyrimidine analog and antimetabolite which incorporates into the DNA molecule and stops DNA synthesis;
• IRIN – irinotecan (Camptosar), a topoisomerase inhibitor, which prevents DNA from uncoiling and duplicating; and
• OX – oxaliplatin (Eloxatin), a platinum-based antineoplastic agent, which inhibits DNA repair and/or DNA synthesis.

The regimen emerged in 2010 as a new treatment for patients with metastatic pancreatic cancer.^[1][2][3] A 2011 study published in the New England Journal of Medicine found that FOLFIRINOX produced the longest improvement in survival ever seen in a phase III clinical trial of patients with advanced pancreatic cancer, with patients on the FOLFIRINOX treatment living approximately four months longer than patients receiving the standard gemcitabine treatment (11.1 months compared with 6.8 months).^[4][5] However, FOLFIRINOX is a potentially highly toxic combination of drugs with serious side effects, and only patients with good performance status are candidates for the regimen.^[4][6]

In 2013, the U.S. Food and Drug Administration approved protein-bound paclitaxel (also known as nab-paclitaxel, sold as Abraxane) used with gemcitabine. This regimen may be less toxic—but perhaps less effective—alternative to FOLFIRINOX for treating late-stage pancreatic cancer. Differences in the trials, and the lack of a direct trial comparing the two regimens, preclude a final conclusion.^[6] In the United Kingdom, the National Institute for Health and Care Excellence (NICE), in a draft guidance issued in 2014, rejected that treatment due to concerns of side effects, efficacy, and cost relative to Gemzar (gemcitabine).^[7]

See also

• FOLFIRI
• FOLFOX
• FOLFOXIRI
• IFL

References

1. Conroy, T; Gavoille, C; Samalin, E; Ychou, M; Ducreux, M (2013). "The role of the FOLFIRINOX regimen for advanced pancreatic cancer". Current Oncology Reports 15 (2): 182–189. doi:10.1007/s11912-012-0290-4. PMID 23341367.
2. Faris, JE; Blaszkowsky, LS; McDermott, S; et al. (2013). "FOLFIRINOX in locally advanced pancreatic cancer: the Massachusetts General Hospital Cancer Center experience". Oncologist 18 (5): 543–548. doi:10.1634/theoncologist.2012-0435. PMC 3662845. PMID 23657686.
3. "FOLFIRINOX". Pancreatic Cancer Association. Retrieved September 6, 2013.
4. "Chemotherapy Regimen Extends Survival in Advanced Pancreatic Cancer Patients". National Cancer Institute. Retrieved September 6, 2013.
5. Conroy, T; Desseigne, F; Ychou, M; et al, on behalf of Groupe Tumeurs Digestives of Unicancer, PRODIGE Intergroup (2011). "FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer". New England Journal of Medicine 364 (19): 1817–1825. doi:10.1056/nejmoa1011923. PMID 21561347.
6. Thota, R; Pauff, JM; Berlin, JD (Jan 2014). "Treatment of metastatic pancreatic adenocarcinoma: a review.". Oncology (Williston Park, N.Y.) 28 (1): 70–4. PMID 24683721.
7. "The cost of nab-paclitaxel is not justified by its limited benefit, says NICE in draft guidance" (Press release). National Institute for Health and Care Excellence. 30 December 2014. Retrieved 2015-03-04.