mFOLFIRINOX – significant survival increase in pancreatic carcinoma treatment
In the new study, the combined treatment of Folfirinox or modified Folfirinox (mFOLFIRINOX) showed impressive results of patients survival with non-metastatic adenocarcinoma of the pancreatic duct (PDAC) after surgical resection, with good performance status.
WHAT INCLUDES A MODIFIED TREATMENT FOR FOLFIRINOX TREATMENT?
This protocol is a part of an adjuvant treatment, and includes a combination of the following drugs:
The adjuvant therapy of malignant cells according to the Folfirinox scheme shows a significant life increase in patients with pancreatic adenocarcinoma (maximum 4.5 years):
♦ The median overall survival was 54.5 months with mFOLFIRINOX, compared with 35 months with gemcitabine;
♦ The median relapse-free survival was 21.6 months versus 12.8 months, accordingly.
At the moment, research and treatment using this protocol is carried out in many clinics around the world, including in Israel. The mFOLFIRINOX scheme itself was approved by the FDA (US Food and Drug Administration) in 2015 as a second-line treatment for pancreatic cancer and shows the best results that were ever obtained with an adjuvant treatment for pancreatic carcinoma.
The modified version of the Folfirinox protocol does not contain a bolus of fluorouracil, does not cause side effects on the gastrointestinal tract and has the same therapeutic effect as the original scheme.
EFFICIENCY OF THE MFOLFIRINOX SCHEME IS PROVED ON THE BASIS OF 77 MEDICAL CENTERS
According to Thierry Conroy, MD and Director of the Medical Oncology Institute at Lorraine in Nancy, France, the combination of drugs adjuvant therapy according to the Folfirinox scheme has been so effective that now standard gemcitabine chemotherapy in such patients fades into the background.
The study itself sponsored by UNICANCER (France), the French National Cancer Institute and the Canadian Cancer Society, was conducted at 77 medical centers in France and Canada. It had 493 participants. After resection, they were divided into two groups randomly – the group with the classical gemcitabine and modified Folfinirox scheme.
Comparison of the mFolfirinox regimen and the classical treatment regimen, in groups:
♦ Median total relapse-free survival – 30.4 – 17.0 (months)
♦ The median of three-year relapse-free survival – 39.7% – 21.4%
♦ Overall three-year survival rate – 63.4% versus 48.6%
♦ Three-year specific survival – 66.2% – 51.2%
♦ Grade 3-4 cancer – 76% – 53%
♦ Death – 0 – 1
This new standard of treatment is already being actively implemented by the leading oncologists of Israel and is applied to patients with a good status performance. The results of the long-term study of the Folfirinox protocol, which is now in phase 3 of the clinical study, and the results of which have already been made public at the annual meeting of the American Society of Clinical Oncology (ASCO) in 2018, show an increase in survival by 15% over three years. The possibility of using the mFolfirinox regimen as a neoadjuvant and preoperative chemotherapy is being studied.
SCHEME OF FOLFIRINOX AS AN ALTERNATIVE TO CLASSICAL CHEMOTHERAPY
Despite the grim prognosis for pancreatic carcinoma, the encouraging result shows an increase in median survival to 4.5 years, more than double compared with the standard chemotherapy gemcitabine. This protocol is also a more economical option.
“Earlier, the Folfirinox scheme was used more in patients with distant metastases and proved its effectiveness, and the use of the modified FOLFIRINOX variant in adjuvant treatment in patients with resectable pancreatic cancer shows an even greater effect,” – confirms Daniel Labou, MD and head of the surgery department of the Maunt-Sinai Hospital, it allows you to change the prognosis for a more favorable and give a more modern and effective treatment regimen.”
This combination of immunotherapy drugs and surgery for pancreatic carcinoma is already becoming the gold standard of treatment in Israeli clinics under the guidance of the best oncologists and surgeons.
The main problem with standard chemotherapy treatment with gemcitabine and fluoropyrimidine is the relapse in 71-76% of patients within two years, so it is time to search for more effective regimens and fundamental changes in this field.
Source: Medscape / Best Survival Ever in Resectable Pancreatic Cancer / Roxanne Nelson, BSN, RN, June 04, 2018.