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FOLFIRINOX as Neoadjuvant Therapy for Pancreatic Cancer

The idea behind treating surgically unresectable and borderline resectable pancreatic cancer (ductal adenocarcinoma of the pancreas) with chemotherapy or chemoradiation is that some minority of cases will thereupon improve to the point of now being deemed amenable to surgery, with its typically more favorable outcome.  This is generally the point then of so-called neoadjuvant therapy.

As the 5-FU based four-drug FOLFIRINOX regimen appears to show improved outcomes for advanced pancreatic cancer over gemcitabine alone, Bahary and colleagues at the University of Pittsburgh used FOLFIRINOX as neoadjuvant therapy in unresectable and borderline resectable pancreatic cancer.  The results were published in the September 2013 issue of the Journal of Surgical Oncology.

The researchers treated 21 such pancreatic cancer patients with the drug combination; seven patients were then able to progress to surgery (two of these patients were initially found to have been unresectable).  An additional two patients were deemed fit for surgery who were treated with both FOLFIRINOX and stereotactic body radiation therapy.

The authors found the results of FOLFIRINOX neoadjuvant treatment for surgically unresectable and borderline resectable pancreatic cancer as encouraging.   This approach is certainly worthy of further study.

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Dale O’Brien, MD