From the Guidelines
The response rate of mFOLFIRINOX in borderline resectable pancreatic cancer is approximately 30-45%, as reported in recent studies 1. This chemotherapy regimen has shown promising results in small series of patients with borderline resectable lesions.
- The regimen consists of folinic acid (leucovorin)/5-FU/irinotecan/oxaliplatin, and has been associated with improved R0 resection rates and promising survival rates.
- The use of mFOLFIRINOX as a neoadjuvant treatment has been proposed to improve disease control and intensify the treatment of systemic disease, with some series reporting better survival using a multimodal strategy than that observed with upfront surgery in patients with clearly resectable tumors 1.
- However, it's essential to note that the heterogeneity of the trials on neoadjuvant therapy in borderline resectable pancreatic cancer limits the power of any conclusion, and patients should be included in clinical trials wherever possible.
- If clinical trials are not feasible, a period of chemotherapy followed by chemoradiation and then surgery appears to be the best option, with mFOLFIRINOX being a viable choice for chemotherapy 1.
From the Research
Response Rate of mFOLFIRINOX in Borderline Resectable Pancreatic Cancer
- The response rate of mFOLFIRINOX in borderline resectable pancreatic cancer has been studied in several research papers 2, 3, 4.
- A study published in the Journal of gastrointestinal cancer in 2021 found that patients with borderline resectable pancreatic cancer who received FOLFIRINOX tended to have better outcomes, with a median progression-free survival of 17 months and a median overall survival that had not been reached 2.
- Another study published in Current treatment options in oncology in 2013 suggested that neoadjuvant chemotherapy and/or chemoradiation before resection is a rational approach for borderline resectable pancreatic cancer, and that FOLFIRINOX should be evaluated as a potential treatment option 3.
- A study published in Current treatment options in oncology in 2020 recommended that patients with borderline resectable pancreatic ductal adenocarcinoma receive preoperative chemotherapy with or without radiation therapy, and that FOLFIRINOX is a potential option for induction systemic chemotherapy 4.
Efficacy of FOLFIRINOX in Borderline Resectable Pancreatic Cancer
- The efficacy of FOLFIRINOX in borderline resectable pancreatic cancer has been compared to other treatment options, such as gemcitabine plus nab-paclitaxel (GnP) 2.
- The study published in the Journal of gastrointestinal cancer in 2021 found that FOLFIRINOX tended to have better outcomes than GnP, with a higher median progression-free survival and a lower percentage of patients dying from progressive disease 2.
- However, another study published in Therapeutic advances in medical oncology in 2025 found that maintenance therapy with capecitabine, an oral formulation of 5-FU, may be a valuable option for patients with advanced pancreatic cancer controlled using FOLFIRINOX or gemcitabine/nab-Paclitaxel induction treatment 5.
Future Directions for Treatment of Borderline Resectable Pancreatic Cancer
- Further studies are needed to establish a preferred systemic therapy for patients with borderline resectable pancreatic cancer 2, 4.
- Research into new and emerging targeted therapies, such as immunotherapies and precision therapeutics, may also lead to improved treatment options for borderline resectable pancreatic cancer 6.