Standard versus Modified FOLFIRINOX Protocols in Patients with Metastatic Pancreatic Carcinoma: Efficacy versus Toxicity


Background: FOLFIRINOX revolutionized the management of patients with 
metastatic pancreatic adenocarcinoma (MPA). However, studies have shown 
severe toxicity profile leading to its limitation as a standard of care protocol. 
Aim: Comparison between standard and modified FOLFIRINOX in terms of 
response rate (RR) and toxicity profile among patients with MPA.
Methods: We reviewed the medical records of 34 patients diagnosed with 
MPA, they were divided into two groups: standard FOLFIRINOX or modified 
FOLFIRINOX in the first line setting.
Results: We observed no statistically significant differences in terms of 
response rate between the two treatment arms 30% in the standard arm and 28.6 
% in the modified arm respectively. the toxicity profile was slightly better in the 
modified arm, namely, dose reductions14.2% vs 40 % favoring modified arm, 
treatment delay 28.5 % vs 50 % in the standard arm and toxicity mandating 
hospitalization 21.4 % vs 30 % also favoring modified arm, however this didn’t 
reach statistically significant difference.
Conclusion: Modified FOLFIRINOX presents comparable activity compared to 
standard FOLFIRINOX in MPA in terms of response rate and toxicity profile 
favoring the modified protocol.