FOLFIRINOX: Desert, Oasis, or Mirage?

Excerpt

Unfortunately, most patients with PDAC present with advanced disease. In addition to the large number who present with distant metastases, approximately 40 % of patients with pancreatic adenocarcinoma present with locally advanced or borderline resectable disease (LAPDC).1 Furthermore, systemic disease is identified in 30 % of patients with LAPDAC during early cycles of treatment.2 The cynics believe that a much larger percentage, if not all, of these patients have micrometastatic disease at the time of diagnosis. The understanding that locally advanced and borderline resectable lesions are more advanced and that an R1 resection decreases overall survival has prompted aggressive neoadjuvant approaches.3,4 Based on the ACCORD-11 trial different institutions have utilized FOLFRINOX in patients with locally advanced and borderline resectable PDAC.5‐8 Similar to Blazer et al.’s results, this has resulted in increased resectability rates. Until recently, only 30 % of patients were converted from unresectable to resectable candidates with chemotherapy and/or chemoradiation therapy.9 In the series by Blazer et al., 51 % of patients became resectable after 4 months of modified FOLFIRINOX ± chemoradiation, and progression was seen in only 15 % of patients. …