Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort

A. A. van Zweeden; L. G.M. van der Geest; E. N. Pijnappel; J. de Vos-Geelen; J. E. van Hooft; M. W.J. Stommel; G. F. de Wit; H. M.W. Verheul; H. W.M. van Laarhoven; H. J. van der Vliet; J. W. Wilmink; Dutch Pancreatic Cancer Group

doi:10.1016/j.pan.2025.03.011

Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort

A. A. van Zweeden, L. G.M. van der Geest, E. N. Pijnappel, J. de Vos-Geelen, J. E. van Hooft, M. W.J. Stommel, G. F. de Wit, H. M.W. Verheul, H. W.M. van Laarhoven, H. J. van der Vliet, J. W. Wilmink^*, Dutch Pancreatic Cancer Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) can improve the prognosis of advanced pancreatic ductal adenocarcinoma (PDAC). Upon progression after a therapy-free interval it is not uncommon to reintroduce FOLFIRINOX, depending on the response and progression free interval after first-line FOLFIRINOX. The aim of this study is to provide an overview of the use and effectiveness of FOLFIRINOX reintroduction in daily practice. Patients and methods: Patients with locally advanced and metastatic PDAC, diagnosed between 2015 and 2018, who started systemic treatment with palliative intent were selected from the Netherlands Cancer Registry (NCR). Overall and progression free survival (OS, PFS) were evaluated using Kaplan-Meier curves with log-rank tests. Results: In this cohort of 2092 patients, most were treated with first-line FOLFIRINOX (1381; 66 %). The median OS was 9.0 months. A total of 388 patients (28 %) received subsequent systemic therapy after first-line FOLFIRNOX; 119 (30.7 %) patients were re-treated with FOLFIRINOX after a minimum of 3 months treatment interruption while 269 patients received other therapies, mostly gemcitabine/nab-paclitaxel or gemcitabine monotherapy. The median therapy-free interval between first-line FOLFIRINOX and FOLFIRINOX reintroduction was 7.0 months (p25-p75: 4,6–10,6). Patients underwent a median of 5 cycles (range: 1–32) during initial treatment and 5 cycles (range: 1–28) during FOLFIRINOX reintroduction. Median OS after FOLFIRINOX reintroduction was 23.4 months, and median progression-free survival was 6.8 months. Conclusion: Reintroduction of FOLFIRINOX after at least 3 months therapy-free interval is used in daily practice and seems a reasonable treatment option based on a favorable OS and PFS in a small subset of patients.

Original language	English
Journal	Pancreatology
DOIs	https://doi.org/10.1016/j.pan.2025.03.011
Publication status	E-pub ahead of print - 1 Jan 2025

Keywords

Cohort study
Drug holiday
FOLFIRINOX
Pancreatic cancer
Retrospective real world data

Access to Document

10.1016/j.pan.2025.03.011

Cite this

van Zweeden, A. A., van der Geest, L. G. M., Pijnappel, E. N., de Vos-Geelen, J., van Hooft, J. E., Stommel, M. W. J., de Wit, G. F., Verheul, H. M. W., van Laarhoven, H. W. M., van der Vliet, H. J., Wilmink, J. W., & Dutch Pancreatic Cancer Group (2025). Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort. Pancreatology. Advance online publication. https://doi.org/10.1016/j.pan.2025.03.011

@article{5eda0717a8f348f5b9a42ef3a89fb8e4,

title = "Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort",

abstract = "Background: FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) can improve the prognosis of advanced pancreatic ductal adenocarcinoma (PDAC). Upon progression after a therapy-free interval it is not uncommon to reintroduce FOLFIRINOX, depending on the response and progression free interval after first-line FOLFIRINOX. The aim of this study is to provide an overview of the use and effectiveness of FOLFIRINOX reintroduction in daily practice. Patients and methods: Patients with locally advanced and metastatic PDAC, diagnosed between 2015 and 2018, who started systemic treatment with palliative intent were selected from the Netherlands Cancer Registry (NCR). Overall and progression free survival (OS, PFS) were evaluated using Kaplan-Meier curves with log-rank tests. Results: In this cohort of 2092 patients, most were treated with first-line FOLFIRINOX (1381; 66 %). The median OS was 9.0 months. A total of 388 patients (28 %) received subsequent systemic therapy after first-line FOLFIRNOX; 119 (30.7 %) patients were re-treated with FOLFIRINOX after a minimum of 3 months treatment interruption while 269 patients received other therapies, mostly gemcitabine/nab-paclitaxel or gemcitabine monotherapy. The median therapy-free interval between first-line FOLFIRINOX and FOLFIRINOX reintroduction was 7.0 months (p25-p75: 4,6–10,6). Patients underwent a median of 5 cycles (range: 1–32) during initial treatment and 5 cycles (range: 1–28) during FOLFIRINOX reintroduction. Median OS after FOLFIRINOX reintroduction was 23.4 months, and median progression-free survival was 6.8 months. Conclusion: Reintroduction of FOLFIRINOX after at least 3 months therapy-free interval is used in daily practice and seems a reasonable treatment option based on a favorable OS and PFS in a small subset of patients.",

keywords = "Cohort study, Drug holiday, FOLFIRINOX, Pancreatic cancer, Retrospective real world data",

author = "{van Zweeden}, {A. A.} and {van der Geest}, {L. G.M.} and Pijnappel, {E. N.} and {de Vos-Geelen}, J. and {van Hooft}, {J. E.} and Stommel, {M. W.J.} and {de Wit}, {G. F.} and Verheul, {H. M.W.} and {van Laarhoven}, {H. W.M.} and {van der Vliet}, {H. J.} and Wilmink, {J. W.} and {Dutch Pancreatic Cancer Group}",

note = "Funding Information: The authors would like to thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for collecting and preparation of the NCR database. Publisher Copyright: {\textcopyright} 2025 IAP and EPC",

year = "2025",

month = jan,

day = "1",

doi = "10.1016/j.pan.2025.03.011",

language = "English",

journal = "Pancreatology",

issn = "1424-3903",

publisher = "Elsevier B.V.",

}

van Zweeden, AA, van der Geest, LGM, Pijnappel, EN, de Vos-Geelen, J, van Hooft, JE, Stommel, MWJ, de Wit, GF, Verheul, HMW, van Laarhoven, HWM, van der Vliet, HJ, Wilmink, JW & Dutch Pancreatic Cancer Group 2025, 'Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort', Pancreatology. https://doi.org/10.1016/j.pan.2025.03.011

TY - JOUR

T1 - Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort

AU - van Zweeden, A. A.

AU - van der Geest, L. G.M.

AU - Pijnappel, E. N.

AU - de Vos-Geelen, J.

AU - van Hooft, J. E.

AU - Stommel, M. W.J.

AU - de Wit, G. F.

AU - Verheul, H. M.W.

AU - van Laarhoven, H. W.M.

AU - van der Vliet, H. J.

AU - Wilmink, J. W.

AU - Dutch Pancreatic Cancer Group

N1 - Funding Information: The authors would like to thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for collecting and preparation of the NCR database. Publisher Copyright: © 2025 IAP and EPC

PY - 2025/1/1

Y1 - 2025/1/1

N2 - Background: FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) can improve the prognosis of advanced pancreatic ductal adenocarcinoma (PDAC). Upon progression after a therapy-free interval it is not uncommon to reintroduce FOLFIRINOX, depending on the response and progression free interval after first-line FOLFIRINOX. The aim of this study is to provide an overview of the use and effectiveness of FOLFIRINOX reintroduction in daily practice. Patients and methods: Patients with locally advanced and metastatic PDAC, diagnosed between 2015 and 2018, who started systemic treatment with palliative intent were selected from the Netherlands Cancer Registry (NCR). Overall and progression free survival (OS, PFS) were evaluated using Kaplan-Meier curves with log-rank tests. Results: In this cohort of 2092 patients, most were treated with first-line FOLFIRINOX (1381; 66 %). The median OS was 9.0 months. A total of 388 patients (28 %) received subsequent systemic therapy after first-line FOLFIRNOX; 119 (30.7 %) patients were re-treated with FOLFIRINOX after a minimum of 3 months treatment interruption while 269 patients received other therapies, mostly gemcitabine/nab-paclitaxel or gemcitabine monotherapy. The median therapy-free interval between first-line FOLFIRINOX and FOLFIRINOX reintroduction was 7.0 months (p25-p75: 4,6–10,6). Patients underwent a median of 5 cycles (range: 1–32) during initial treatment and 5 cycles (range: 1–28) during FOLFIRINOX reintroduction. Median OS after FOLFIRINOX reintroduction was 23.4 months, and median progression-free survival was 6.8 months. Conclusion: Reintroduction of FOLFIRINOX after at least 3 months therapy-free interval is used in daily practice and seems a reasonable treatment option based on a favorable OS and PFS in a small subset of patients.

AB - Background: FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) can improve the prognosis of advanced pancreatic ductal adenocarcinoma (PDAC). Upon progression after a therapy-free interval it is not uncommon to reintroduce FOLFIRINOX, depending on the response and progression free interval after first-line FOLFIRINOX. The aim of this study is to provide an overview of the use and effectiveness of FOLFIRINOX reintroduction in daily practice. Patients and methods: Patients with locally advanced and metastatic PDAC, diagnosed between 2015 and 2018, who started systemic treatment with palliative intent were selected from the Netherlands Cancer Registry (NCR). Overall and progression free survival (OS, PFS) were evaluated using Kaplan-Meier curves with log-rank tests. Results: In this cohort of 2092 patients, most were treated with first-line FOLFIRINOX (1381; 66 %). The median OS was 9.0 months. A total of 388 patients (28 %) received subsequent systemic therapy after first-line FOLFIRNOX; 119 (30.7 %) patients were re-treated with FOLFIRINOX after a minimum of 3 months treatment interruption while 269 patients received other therapies, mostly gemcitabine/nab-paclitaxel or gemcitabine monotherapy. The median therapy-free interval between first-line FOLFIRINOX and FOLFIRINOX reintroduction was 7.0 months (p25-p75: 4,6–10,6). Patients underwent a median of 5 cycles (range: 1–32) during initial treatment and 5 cycles (range: 1–28) during FOLFIRINOX reintroduction. Median OS after FOLFIRINOX reintroduction was 23.4 months, and median progression-free survival was 6.8 months. Conclusion: Reintroduction of FOLFIRINOX after at least 3 months therapy-free interval is used in daily practice and seems a reasonable treatment option based on a favorable OS and PFS in a small subset of patients.

KW - Cohort study

KW - Drug holiday

KW - FOLFIRINOX

KW - Pancreatic cancer

KW - Retrospective real world data

U2 - 10.1016/j.pan.2025.03.011

DO - 10.1016/j.pan.2025.03.011

M3 - Article

SN - 1424-3903

JO - Pancreatology

JF - Pancreatology

ER -

Reintroduction of palliative intent FOLFIRINOX chemotherapy in a real world pancreatic cancer cohort

Abstract

Keywords

Access to Document

Fingerprint

Cite this