folfirinox

Overview

FOLFIRINOX is a four-drug chemotherapy regimen comprising oxaliplatin (platinum-based DNA crosslinker), irinotecan (topoisomerase I inhibitor), leucovorin (folinic acid modulator), and fluorouracil (pyrimidine antimetabolite). It is a standard first-line regimen for metastatic and locally advanced pancreatic adenocarcinoma in patients with adequate performance status, and is also used in the neoadjuvant setting for borderline-resectable pancreatic cancer.

Evidence in the corpus

  • KRASG12R-mutant PAAD patients were enriched among those receiving neoadjuvant FOLFIRINOX followed by resection (32.7% vs 17.9% for KRASG12D, p=0.094) in a 1,360-patient MSK PDAC cohort; the authors suggest this may reflect greater KRAS-allele-specific chemosensitivity rather than purely borderline-resectable case selection PMID:39214094.
  • FOLFIRINOX was administered to 38% of the curated 1,480-patient MSK PDAC clinicogenomic cohort as first-line systemic therapy; gemcitabine/nab-paclitaxel was used in 37%. Chemotherapy backbone choice between these two regimens was not significantly associated with overall survival in the n=304 metastatic chemotherapy-treated subset PMID:39753968.
  • FOLFIRINOX combined with SBRT is under evaluation in two prospective trials cited in this 2016 review (NCT01992705, NCT01446458) for locally advanced PAAD; no efficacy data were available at time of publication, but the combination is highlighted as a priority investigation given FOLFIRINOX’s established OS benefit in metastatic disease PMID:27826200

Resistance mechanisms

  • No specific FOLFIRINOX resistance mechanisms reported in the corpus at this time. KRAS mutant-allele dosage gains were prognostic for shorter OS independent of first-line chemotherapy backbone PMID:39753968.

Cancer types (linked)

  • PAAD — pancreatic adenocarcinoma; dominant first-line regimen (38% of curated MSK cohort), with possible KRAS allele-specific chemosensitivity in KRASG12R tumors.

Sources

  • PMID:39214094 — McIntyre et al. 2024, Cancer Cell. KRAS allele-specific PDAC outcomes; FOLFIRINOX enrichment in KRASG12R neoadjuvant patients.
  • PMID:39753968 — Varghese et al. 2025, Nature Medicine. MSK PDAC clinicogenomic landscape; FOLFIRINOX as standard first-line regimen.
  • PMID:27826200 — Tchelebi et al. 2016, Semin Radiat Oncol. SBRT in pancreatic cancer review; FOLFIRINOX + SBRT as investigational combination (NCT01992705, NCT01446458).

This page was processed by entity-page-writer on 2026-05-15.