Evaluation of the Efficacy and Safety of FOLFOX in First-Line Treatment of Advanced Pancreatic Cancer

Objective: In pancreatic cancer, only 15% to 20% of patients are potentially resectable at diagnosis. Current standard treatment for inoperable and metastatic patients includes: FOLFIRINOX, gemcitabine plus nab-paclitaxel, and NALIRIFOX regimens. Fluorouracil-based treatments can be considered in patient groups with Eastern Cooperative Oncology Group (ECOG) 1-2, advanced age, and multiple comorbidities. Material and Methods: We aimed to evaluate overall survival (OS), progression-free survival (PFS), safety, and laboratory data in patients with unresectable locally advanced and metastatic pancreatic cancer (ECOG performance score 1) who were treated with FOLFOX as first-line therapy. 46 patients, who were started on FOLFOX in University of Health Sciences Türkiye, Gülhane Training and Research Hospital between June 1, 2016 and May 1, 2024, were evaluated retrospectively. Results: The median age was 68. 13 patients were locally advanced (28.3%), and 33 patients were in the metastatic stage (71.7%). Partial response was seen in 13 patients (28.2%) and stable response was seen in 19 patients (41.3%) (disease control rate; 69.6%). Median PFS was 5.8 months; median OS was 13.7 months. No patient with locally advanced disease could be operated on during the follow-up. PFS (10 vs. 5 months; p<0.0005) and OS (22 vs. 8 months, p<0.0005) were better for locally advanced disease compared to metastatic disease. Grade 3/4 neutropenia was 21.7%; anemia was 13%, and thrombocytopenia was 13%. Grade 3/4 diarrhea 6.5%. Conclusion: In locally advanced and metastatic pancreatic cancer, the FOLFOX regimen is considered a good alternative treatment protocol in the low performance status, fragile patient group with efficacy and safety data.