A recent study titled “Real-world dose reduction of standard and modified FOLFIRINOX in metastatic pancreatic cancer: a systematic review, evidence-mapping, and meta-analysis” conducted by a team of researchers aimed to analyze the trends and outcomes of dose modifications in FOLFIRINOX treatment for metastatic pancreatic cancer (MPC).

FOLFIRINOX is a highly effective chemotherapy regimen used for the treatment of MPC. However, it is also associated with significant toxicity. To reduce these toxicities, various dose modifications have been introduced in clinical practice. The objective of this study was to map the 10-year trend of planned and actual doses of FOLFIRINOX and investigate the clinical outcomes associated with dose modification.

The researchers conducted a comprehensive systematic literature search from January 2011 to September 2021 to identify relevant studies on FOLFIRINOX as a first-line treatment for MPC. The selected studies were classified based on prospective or retrospective research, standard or modified FOLFIRINOX, and planned or actual dose modifications. To map the trend of dose modification, the researchers developed a web-based interactive bubble-plot program called RDI-map.com. The comparison of clinical outcomes focused on objective response rate (ORR) and hematologic toxicity.

A total of 37 studies were included in the evidence mapping analysis, including 11 prospective and 26 retrospective studies. The researchers found that there were 12 different types of planned dose modifications for FOLFIRINOX, with varying percentages of oxaliplatin, irinotecan, and 5-fluorouracil (5-FU) bolus and continuous injection. However, the actual doses administered in clinical practice were further reduced compared to the planned doses.

When comparing the standard FOLFIRINOX regimen with the modified regimen, the study found that the modified regimen showed similar efficacy in terms of ORR. The ORR was 33.8% for the modified regimen compared to 28.2% for the standard regimen, although this difference was not statistically significant. Importantly, the modified regimen was associated with a reduced incidence of febrile neutropenia, a serious side effect of chemotherapy. The incidence of febrile neutropenia was 5.5% for the modified regimen compared to 11.6% for the standard regimen.

In conclusion, the study highlights the lack of consistency in dose modifications for FOLFIRINOX in clinical practice. The actual doses administered were often lower than the planned doses. However, the modified regimen showed similar efficacy to the standard regimen with a reduced incidence of febrile neutropenia. The findings of this study provide valuable insights for clinicians in optimizing the use of FOLFIRINOX in the treatment of metastatic pancreatic cancer.