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FOLFIRINOX Induces a Full Pathological Response Leading to Resectability in Pancreatic Cancer

The four-drug FOLFIRINOX regimen represents a standard-of-care initial treatment for pancreatic cancer (ductal adenocarcinoma of the pancreas) despite substantive side-effects. Along with the gemcitabine plus Abraxane combination therapy it appears to offer survival advantage in pancreatic cancer over gemcitabine given alone. And increasingly, FOLFIRINOX is offered as therapy for locally advanced and “borderline resectable” pancreatic cancer with some studies particularly in the past couple of years or so indicating respectable success at converting non-surgical patient status into candidates for surgery.

Now comes a case study of a patient, by way of highlighting the increasing possibilities of FOLFIRINOX in the treatment of these stages of pancreatic cancer, who achieved a rather remarkable response from the regimen. These results were reported by researchers from the University of Ottawa in Canada who published their findings in the October 2016 peer-reviewed open access journal, BMC Cancer. They indicate that they treated a 61-year-old female at their institution who was staged as borderline resectable pancreatic cancer with 13 cycles of FOLFIRINOX. A follow-up CT scan demonstrated that the pancreatic cancer tumor was significantly reduced in sized compared to the original scan (the noted tumor had been more definitely characterized via EUS fine-needle biopsy and histology review as ductal adenocarcinoma of the pancreas).

The patent underwent a Whipple procedure with the intent of potential cure. Pathology examination at the time of surgery demonstrated no evidence of disease in the excised tissue including none in the 23 lymph nodes taken. The researchers indicated that at 15 months post-surgery the patient appeared to have remained free of pancreatic cancer.

The authors note that there has been a paucity of studies in the medical literature describing complete pathological remission in borderline resectable or locally advanced pancreatic cancer treated with the FOLFIRINOX regimen. And they suggest in reaction to the mounting evidence of likely favorable response that clinical trials might be in order to more rigorously explore the indications and outcomes of FOLFIRINOX treatment in these stages of pancreatic cancer. It seems difficult not to concur with this recommendation.

 

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Dale O’Brien, MD

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