FOLFIRINOX

FOLFIRINOX is a chemotherapy regimen used in the treatment of pancreatic ductal adenocarcinoma. It combines folinic acid (leucovorin), fluorouracil (5-FU), irinotecan, and oxaliplatin, given intravenously in cycles. The standard regimen is delivered every two weeks and includes leucovorin 400 mg/m2 IV, oxaliplatin 85 mg/m2 IV, irinotecan 165 mg/m2 IV, a 5-FU bolus 400 mg/m2 IV followed by 5-FU continuous infusion of 2400 mg/m2 over 46 hours.

Modified FOLFIRINOX (mFOLFIRINOX) uses reductions in one or more components, most commonly lowering irinotecan to 150 mg/m2, omitting the 5-FU bolus, or reducing oxaliplatin dose, to lessen toxicity.

Indications for FOLFIRINOX include metastatic pancreatic cancer in patients with good performance status. It is also used in select patients as neoadjuvant (preoperative) or adjuvant therapy, particularly in resectable or borderline resectable disease. In the adjuvant setting, studies have shown that a modified FOLFIRINOX regimen can improve disease-free and overall survival compared with gemcitabine.

Evidence and safety: In randomized trials, FOLFIRINOX improved overall survival and progression-free survival compared with gemcitabine in metastatic disease but caused higher rates of severe adverse events, including neutropenia, febrile neutropenia, diarrhea, and neuropathy. Management requires close monitoring of blood counts and organ function, and dose modifications or growth factor support may be needed.

Considerations: Treatment is not suitable for all patients, particularly those with poor performance status, advanced age, or significant comorbidity. Supportive care and multidisciplinary assessment are essential. FOLFIRINOX remains one option among regimens for pancreatic cancer, with selection based on disease stage, performance status, and patient preferences.