Dr. Weinberg Discusses the Use of FOLFIRINOX in Older Patients With Metastatic Pancreatic Cancer

Benjamin Weinberg, MD, assistant professor of medicine, Division of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, discusses the use of FOLFIRINOX in older patients with metastatic pancreatic cancer.

Historically, FOLFIRINOX has been reserved for younger patients with a good performance status. However, in February 2019, investigators at The University of Texas MD Anderson Cancer Center published a study in the Journal of Clinical Oncology on the use of FOLFIRINOX in patients with unresectable pancreatic cancer aged 75 or older. Although the study was a single-center retrospective analysis, it showed similar survival outcomes to the initial PRODIGE trial, which served as the basis for the regimen’s FDA approval.

In practice, Weinberg tends to dose reduce to make the regimen more tolerable for all patients. Additionally, white blood cell growth factor support is often used for patients who have low blood counts on the regimen.

In addition to FOLFIRINOX, the combination of gemcitabine and nab-paclitaxel (Abraxane) is also approved by the FDA for frontline use. However, in the trials that led to their approvals, both regimens were compared with single-agent gemcitabine. There are no head-to-head data comparing the 2 regimens. Moving forward, physicians will need access to better tests to determine which patient should receive a 5-fluorouracil—based regimen and which patient should receive a gemcitabine-based regimen, concludes Weinberg.