Recent advances in treatment of pancreatic cancer promises to provide improved survival outcomes, particularly for locally advanced pancreatic cancer (LAPC). This is defined as a pancreatic tumour, causing invasion into blood vessels such as the superior mesenteric vein, portal vein and hepatic artery. A LAPC has very poor survival rate, because curative pancreatic resection is often not feasible.
A landmark study published in New England Journal of Medicine, 2011 (Conroy T et al) demonstrated that a combination of chemotherapy using FOLFIRINOX compared to Gemcitabine was associated with a survival advantage in patients (n = 342 patients) with metastatic pancreatic cancer (median overall survival 11.1 months vs. 6.8 months). However, this was associated with increased toxicity.
A recent study published in British Journal of Cancer, 2016 (Stein SM et al) showed a modified FOLFIRINOX regime had lower toxicity compared to full dose of FOLFIRINOX. Furthermore, patients with LAPC had 17.2% response rate and 41.9% resection rate with overall survival 26.6 months. These are encouraging results for patients with locally advanced pancreatic cancer, who are often told that pancreatic surgery is not possible at the time of diagnosis. Those who respond to preoperative FOLFIRINOX chemotherapy may be suitable for potentially curative pancreatic resection.