Metastatic Pancreatic Carcinoma and Experience with FOLFIRINOX - a Cross Sectional Analysis From a Developing Country

Background: Pancreatic cancer is the fourth leading cause of cancer related death with median survivalranging from 3 to 6 months for metastatic disease. Palliative chemotherapy has been the backbone of treatmentin advanced stage and has evolved over time. Data pertaining to the disease are scarce from our part of the worldwhere treatment poses a significant challenge due to lack of resources. Materials and
Methods: A retrospectivechart review was performed for all patients presenting with stage IV pancreatic carcinoma at a tertiary carehospital in Karachi, Pakistan between January 2008 and December 2012. Data were collected using a pre-designed,coded questionnaire looking at patient characteristics, treatment given and outcome.
Results: 101 patients werefound to be eligible. Mean age was 56.7 ± 12.8 years, the male to female ratio was 2:1 and most patients had agood performance status. More than half of the tumors were located in the head (57%, n=58) and almost allwere adenocarcinomas (95%, n=96). Some 58% (n=59) received first line chemotherapy of which 49% (n=29)received gemcitabine-based regimens and 39% (n=23) received FOLFIRINOX. The median progression freesurvival for gemcitabine based treatment was 2.9 months (IQR=1.6-5.6) as opposed to 7.3 months (IQR=4.5-9.2)for FOLFIRINOX (P=0.02). Median overall survival was 4.9 months (IQR=2.3-9.5) for first line gemcitabinebased treatment and 10.5 months (IQR=7.0-13.2) for first line FOLFIRINOX therapy (P=0.002). Patients onFOLFIRINOX had better survival across all subgroups. Inpatient admissions and dose reductions were morefrequent with FOLFIRINOX but the difference between the two regimens was not statistically significant.FOLFIRINOX could be successfully administered as outpatient therapy to a number of patients.
Conclusions:FOLFIRINOX remains a suitable first line option in patients with metastatic pancreatic cancer with goodperformance status even in a resource-poor country where diagnostic and supportive care facilities may be lessthan optimal and cost is a limitation.