Page 48 - Demo

Chapter 346AbstractBackground: The prognosis of patients with advanced pancreatic ductal adenocarcinoma (PDAC) can be improved by FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin and irinotecan). Upon progression after a therapy-free interval it is not uncommon to reintroduce FOLFIRINOX, depending on the response during and the progression free interval after FOLFIRINOX. The aim of this study is to provide an overview of the use and effectiveness of FOLFIRINOX reintroduction in daily practice. Patients and Methods: Patients with locally advanced and metastatic PDAC diagnosed between 2015-2018 who started systemic treatment with palliative intent were selected from the Netherlands Cancer Registry (NCR). Overall and progression free survival (OS, PFS) were evaluated using Kaplan-Meier curves with log-rank tests. Results: In this cohort (n=2092), most patients were treated with first line FOLFIRINOX (n=1381; 66%). Median OS from diagnosis until death was 9.0 months. A total of 388 patients (28%) received subsequent systemic therapy after first line FOLFIRNOX; 119 of 388 patients (30,7%) were re-treated with FOLFIRINOX after a minimum of 3 months treatment interruption while 269 patients were treated with other subsequent systemic therapy (majority gemcitabine plus nab-paclitaxel or gemcitabine monotherapy). Median therapy-free interval between first line FOLFIRINOX and FOLFIRINOX reintroduction was 7.0 months (p25-p75: 4,6-10,6). Patients underwent a median of 5 cycles (range: 1-32) for the initial treatment and 5 cycles (range: 1-28) for the reintroduction of FOLFIRINOX. Median OS after diagnosis of patients who received FOLFIRINOX reintroduction was 23.4 months. Median PFS after start of FOLFIRINOX reintroduction was 6.8 months. Conclusion: Reintroduction of FOLFIRINOX after at least 3 months therapy-free interval is used in daily practice and seems a reasonable treatment option based on a favorable OS and PFS for in a small subset of patients.