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World J Gastroenterol. Jun 21, 2019; 25(23): 2839-2845
Published online Jun 21, 2019. doi: 10.3748/wjg.v25.i23.2839
Modified FOLFIRINOX for resected pancreatic cancer: Opportunities and challenges
Feng Yang, Chen Jin, De-Liang Fu, Andrew L Warshaw
Feng Yang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
Andrew L Warshaw, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
Author contributions: Yang F collected the materials, discussed the topic, wrote the manuscript, and supervised the publication of this commentary; Jin C and Fu DL discussed the topic; and Warshaw AL discussed the topic and revised the manuscript.
Supported by the National Key R&D Program of China, No. 2017YFC1308604.
Conflict-of-interest statement: We declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Feng Yang, MD, PhD, Associate Professor, Surgeon, Surgical Oncologist, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Central Urumqi Road, Shanghai 200040, China. yffudan98@126.com
Telephone: +86-21-52887164 Fax: +86-21-52888277
Received: March 7, 2019
Peer-review started: March 7, 2019
First decision: April 5, 2019
Revised: April 17, 2019
Accepted: April 29, 2019
Article in press: April 29, 2019
Published online: June 21, 2019
Processing time: 106 Days and 14.4 Hours
Abstract

Pancreatic cancer is one of the leading causes of cancer death worldwide. Adjuvant chemotherapy has been developed based on the experiences made with palliative chemotherapy, and advocated to improve long-term survival of patients with this disease. However, the optimal chemotherapeutic regimen remains controversial. Recently, Conroy et al demonstrated the impressive benefits of modified FOLFIRINOX over gemcitabine alone in the multicenter Partenariat de Recherche en Oncologie Digestive 24 (PRODIGE-24) trial. The remarkable results mark a new milestone in treating resectable pancreatic cancer and have now changed the standard of care for this patient population. In this commentary, we discuss an issue of difference of tumor grade between the PRODIGE-24 trial and previous phase III trials. We also discuss potential biomarkers predicting therapeutic response to modified FOLFIRINOX. Finally, we summarize several ongoing clinical trials of replacing part of the FOLFIRINOX regimen with Xeloda/S-1/nanoliposomal irinotecan for pancreatic cancer.

Keywords: Pancreatic cancer; Adjuvant therapy; FOLFIRINOX; Neutrophil-to-lymphocyte; Nanoliposomal irinotecan

Core tip: Adjuvant chemotherapy for pancreatic cancer has been developed based on the experiences made with palliative chemotherapy. Nevertheless, the optimal regimen remains controversial. The Partenariat de Recherche en Oncologie Digestive 24 trial showed an impressive benefit of modified FOLFIRINOX over gemcitabine alone. The remarkable results mark a new milestone in treating resectable pancreatic cancer and have now changed the standard of care. Here, we discuss an issue of difference between this trial and previous phase III trials, as well as potential biomarkers predicting therapeutic response. Several ongoing trials of replacing part of the FOLFIRINOX regimen with other drugs for pancreatic cancer are also summarized.