FOLFIRINOX

FOLFIRINOX is a chemotherapy regimen for treatment of advanced pancreatic cancer. It is made up of the following four drugs:

  • FOL – folinic acid (leucovorin), a vitamin B derivative that enhances the effects of 5-fluorouracil (5-FU);[1][2]
  • F – fluorouracil (5-FU), a pyrimidine analog and antimetabolite which incorporates into the DNA molecule and stops DNA synthesis;
  • IRIN – irinotecan (Camptosar), a topoisomerase inhibitor, which prevents DNA from uncoiling and duplicating; and
  • OX – oxaliplatin (Eloxatin), a platinum-based antineoplastic agent, which inhibits DNA repair and/or DNA synthesis.

The regimen emerged in 2010 as a new treatment for patients with metastatic pancreatic cancer.[3][4][5] A 2011 study published in the New England Journal of Medicine found that FOLFIRINOX produced the longest improvement in survival ever seen in a phase III clinical trial of patients with advanced pancreatic cancer, with patients on the FOLFIRINOX treatment living approximately four months longer than patients receiving the standard gemcitabine treatment (11.1 months compared with 6.8 months).[6][7] However, FOLFIRINOX is a potentially highly toxic combination of drugs with serious side effects, and only patients with good performance status are candidates for the regimen.[6][8] Currently FOLFIRINOX is being used to downstage patients with advanced disease with the hope of rendering their tumors amenable to surgical resection.[9]

In 2013, the U.S. Food and Drug Administration approved protein-bound paclitaxel (also known as nab-paclitaxel, sold as Abraxane) used with gemcitabine. This regimen may be less toxic—but perhaps less effective—alternative to FOLFIRINOX for treating late-stage pancreatic cancer. Differences in the trials, and the lack of a direct trial comparing the two regimens, preclude a final conclusion.[8] In the United Kingdom, the National Institute for Health and Care Excellence (NICE), in a draft guidance issued in 2014, rejected that treatment due to concerns of side effects, efficacy, and cost relative to Gemzar (gemcitabine).[10] However, on the 18th of May 2017 NICE issued a reappraisal for the use of Abraxane in the UK. This was in response to Celgene putting forward a Patient Access Scheme (PAS) proposal, which would bring down the cost of the drug.[11]

See also

References

  1. ↑ Moran, R. G.; Keyomarsi, K. (1987). "Biochemical rationale for the synergism of 5-fluorouracil and folinic acid". NCI Monographs (5): 159–63. PMID 2963229.
  2. ↑ "Leucovorin".
  3. ↑ Conroy, T; Gavoille, C; Samalin, E; Ychou, M; Ducreux, M (2013). "The role of the FOLFIRINOX regimen for advanced pancreatic cancer". Current Oncology Reports. 15 (2): 182–189. doi:10.1007/s11912-012-0290-4. PMID 23341367.
  4. ↑ Faris, JE; Blaszkowsky, LS; McDermott, S; et al. (2013). "FOLFIRINOX in locally advanced pancreatic cancer: the Massachusetts General Hospital Cancer Center experience". Oncologist. 18 (5): 543–548. doi:10.1634/theoncologist.2012-0435. PMC 3662845. PMID 23657686.
  5. ↑ "FOLFIRINOX". Pancreatic Cancer Association. Archived from the original on September 17, 2013. Retrieved September 6, 2013.
  6. 1 2 "Chemotherapy Regimen Extends Survival in Advanced Pancreatic Cancer Patients". National Cancer Institute. 7 June 2011. Retrieved September 6, 2013.
  7. ↑ Conroy, T; Desseigne, F; Ychou, M; et al, on behalf of Groupe Tumeurs Digestives of Unicancer, PRODIGE Intergroup (2011). "FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer". New England Journal of Medicine. 364 (19): 1817–1825. doi:10.1056/nejmoa1011923. PMID 21561347.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. 1 2 Thota, R; Pauff, JM; Berlin, JD (Jan 2014). "Treatment of metastatic pancreatic adenocarcinoma: a review". Oncology (Williston Park, N.Y.). 28 (1): 70–4. PMID 24683721.
  9. ↑ Michelakos, T; Pergolini, I; Castillo, CF; Honselmann, KC; Cai, L; Deshpande, V; Wo, JY; Ryan, DP; Allen, JN; Blaszkowsky, LS; Clark, JW; Murphy, JE; Nipp, RD; Parikh, A; Qadan, M; Warshaw, AL; Hong, TS; Lillemoe, KD; Ferrone, CR (April 2019). "Predictors of Resectability and Survival in Patients With Borderline and Locally Advanced Pancreatic Cancer who Underwent Neoadjuvant Treatment With FOLFIRINOX". Annals of Surgery. 269 (4): 733–740. doi:10.1097/SLA.0000000000002600. PMID 29227344.
  10. ↑ "The cost of nab-paclitaxel is not justified by its limited benefit, says NICE in draft guidance" (Press release). National Institute for Health and Care Excellence. 30 December 2014. Retrieved 2015-03-04.
  11. ↑ "NICE announces reappraisal of Abrxane".
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