Standard dosing and delivery of FOLFIRINOX

Clinical Pearls Podcasts published on April 19, 2017
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Andrea Wang-Gillam, MD, PhD
Associate Professor
Clinical Director
GI Oncology Program
Washington University
St. Louis, Missouri

Hi. This is Dr. Andrea Wang-Gillam, I am a medical oncologist specializing in patients with pancreas cancer. Today I will be talking about the front-line regimen FOLFIRINOX. Based on the ACCORD study, FOLFIRINOX has resulted overall survival of 11.1 months compared to 6.7 months in patients receiving gemcitabine. The superior overall survival has put FOLFIRINOX as one of the front-line regimens in patients with pancreas cancer. FOLFIRINOX has toxicity, but it is manageable. The regimen is giving full-dose FOLFOX plus full-dose FOLFIRI with oxaliplatin 85 mg/m², irinotecan of 180 mg/m² and standard 5-FU dose which is bolus 400 mg/m² infusion of 2,400 mg/m² over a 46-hours infusion. The common side effects encountered include neutropenia, thrombocytopenia, and anemia. Additionally, there were non-hematologic adverse events. We have seen fatigue, vomiting, diarrhea, and neuropathy in a clinical setting. Because febrile neutropenia was around 5.4%, it does not mandate prophylactic Neupogen® (filgrastim) or Neulasta® (pegfilgrastim). However there were about 45% of patients in the study who developed neutropenia, so that is something to watch out for. Additionally, patients have fatigue, GI side effects that required close monitoring and frequent IV hydration. This is a tolerable regimen, but does require very vigilant monitoring of patient status.    

Last modified: March 22, 2017
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