Use of first-line chemotherapy for advanced pancreatic cancer: FOLFIRINOX versus gemcitabine-based therapy.

Gastrointestinal (Noncolorectal) Cancer
Session Type and Session Title: 
General Poster Session, Gastrointestinal (Noncolorectal) Cancer
Abstract Number: 
J Clin Oncol 32:5s, 2014 (suppl; abstr 4132)
Thomas H. Cartwright, Aimee Ginsburg, Lalan S. Wilfong, Robyn K. Harrell, J. Russell Hoverman; Ocala Oncology, Ocala, FL; The US Oncology Network/McKesson Specialty Health, The Woodlands, TX; Texas Oncology Presbyterian, Dallas, TX; Texas Oncology, The Woodlands, TX

Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).

Abstract Disclosures


Background: Pancreatic cancer (PC) is the fourth leading cause of death in the United States. It is estimated that 46,420 patients will be diagnosed in 2014 and 35,590 will die (Siegel, CA Cancer J Clin 2014). Gemcitabine has long been the standard of care chemotherapy. Recent advances in treatment created the combination regimens (oxaliplatin, irinotecan, leucovorin, fluorouracil [FOLFIRINOX]) and gemcitabine, nab-paclitaxel (GN) for patients with good Karnofsky performance status (PS) (Conroy, NEJM 2011; Von Hoff, NEJM 2013). This retrospective analysis was conducted as an update to results reported at ASCO 2013 (Cartwright, JCO 2013) to evaluate characteristics and overall survival (OS) of patients receiving FOLFIRINOX and gemcitabine-based treatments in a large outpatient community setting. This is the largest study describing FOLFIRINOX patients to date. Methods: Patients with advanced PC treated at practices in The US Oncology Network entered into the iKnowMed (iKM) database between June 2010 and November 2013 were included. Patterns of treatment were characterized by the median age at diagnosis, sex, PS, and first-line metastatic chemotherapy prescribed. The primary endpoints of the analysis were OS and uptake of FOLFIRINOX within The Network. Results: Compared to ASCO 2013 results, 700 additional patients were identified. Of the 2,422 total patients, 27% received FOLFIRINOX (24% in 2013) and 73% received gemcitabine-based therapy (76% in 2013). Increased utilization of FOLFIRINOX for good PS patients began in June 2010 and GN April 2013. For all patients (55% male), the median age at diagnosis was 67 and 95% had a PS of 70% or greater. When controlled for age and PS, the OS was significantly longer for FOLFIRINOX (11.2 mos) versus gemcitabine (7.2 mos) (p<0.0001). Median OS for GN (n=189) was 10.2 mos, despite shorter follow up time. Conclusions: Utilization of FOLFIRINOX and GN has continued to increase after the publication of phase III trials. Our data in a community setting continues to support a survival advantage for FOLFIRINOX as well as GN. The magnitude of benefit appears slightly better in the community; therefore, we agree that FOLFIRINOX should become a standard of care for good PS patients.