Efficacy of mFOLFIRINOX reinduction in locally advanced unresectable and metastatic pancreatic cancer in real clinical practice

Pancreatic cancer remains one of the most aggressive malignancies with an unfavorable prognosis. Over 50 % of patients present with distant metastases at initial diagnosis and the five-year overall survival in this cohort does not exceed 3 % [1, 2]. In contemporary clinical practice the combination regimens mFOLFIRINOX and GemNab have become firmly established as first-line therapy standards in both Russian (RUSSCO) and international (ESMO, NCCN) clinical guidelines [3, 4, 5]. However determining the optimal therapeutic approach upon disease progression remains challenging due to limited evidence-based options highlighting the need to explore new treatment strategies including the reinduction of previously used regimens. A single-center retrospective study conducted at the N. N. Blokhin National Medical Research Center of Oncology analyzed data from 31 patients with locally advanced or metastatic pancreatic adenocarcinoma who received mFOLFIRINOX reinduction following a progression-free interval of at least 3 months after first-line chemotherapy. The study assessed progression-free survival during first-line therapy (PFS 1) and reinduction (PFS 2), as well as overall survival from diagnosis (OS) and from reinduction initiation (OS 2). Median PFS 1 was 13 months (95 % CI: 11.6–14.4), and median PFS 2 was 7.0 months (95 % CI: 5.7–8.3). Median OS reached 23.0 months (95 % CI: 18.5–27.5), while median OS 2 was 8.0 months (95 % CI: 6.2–9.8). The toxicity profile upon retreatment was comparable to initial treatment with a trend toward reduced hematologic toxicity likely associated with optimized supportive care. In conclusion the preliminary data from our study demonstrate that the mFOLFIRINOX reintroduction strategy is a promising approach in the treatment of patients with locally advanced and metastatic pancreatic cancer. The results indicate clinically meaningful efficacy of regimen reuse, warranting further investigation of this approach.

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