Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2016; 22(42): 9378-9386
Published online Nov 14, 2016. doi: 10.3748/wjg.v22.i42.9378
Folfirinox in elderly patients with pancreatic or colorectal cancer-tolerance and efficacy
Jean-Florian Guion-Dusserre, Aurélie Bertaut, François Ghiringhelli, Julie Vincent, Valérie Quipourt, Sophie Marilier, Zoé Tharin, Leila Bengrine-Lefevre
Jean-Florian Guion-Dusserre, Aurélie Bertaut, François Ghiringhelli, Julie Vincent, Valérie Quipourt, Sophie Marilier, Zoé Tharin, Leila Bengrine-Lefevre, Department of Medical Oncology, Centre Georges-François Leclerc, 21000 Dijon, France
François Ghiringhelli, Julie Vincent, Institut National de la Santé et de la Recherche Médicale, University of Burgundy, 21078 Dijon, France
Author contributions: Guion-Dusserre JF performed the research; Guion-Dusserre JF, Bertaut A and Bengrine-Lefevre L analyzed the data; Guion-Dusserre JF, Ghiringhelli F and Bengrine-Lefevre L wrote the paper; Ghiringhelli F and Bengrine-Lefevre L designed the research; Vincent J, Quipourt V, Marilier S and Bengrine-Lefevre L contributed to providing patients data; Tharin Z helped for translation.
Institutional review board statement: This study was approved by the local insitutional review board.
Informed consent statement: I declare that all patients give written inform consent to participate in clinical research before receiving any therapy.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: No additional data are available.
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:
Correspondence to: Francois Ghiringhelli, MD, PhD, Department of Medical Oncology, Centre Georges François Leclerc, INSERM Avenir 866, 1, rue du Professeur Marion, 21000 Dijon, France.
Telephone: +33-380-737500 Fax: +33-380-737500
Received: June 30, 2016
Peer-review started: July 1, 2016
First decision: July 29, 2016
Revised: August 14, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: November 14, 2016

To study the tolerance and the efficiency of FOLFIRINOX in elderly patients diagnosed with colorectal or pancreatic cancer.


This retrospective study included elderly patients aged over 70 years of age treated at Georges-Francois Leclerc Center by FOLFIRINOX for histological proved colorectal or pancreatic cancer between January 2009 and January 2015. Chemotheapy regimen consisted of oxaliplatin (85 mg/m2 in over 120 min) followed by leucovorin (400 mg/m2 in over 120 min), with the addition, after 30 min of irinotecan (180 mg/m2 in over 90 min) then 5 fluorouracil (5FU) (400 mg/m2 administred intravenous bolus), followed by 5FU (2400 mg/m2 intraveinous infusion over 46 h) repeated every 2 wk. Geriatric parameters were recorded at the beginning. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events 4.03. Tumor response was evaluated by CT scan. Treatment continued until disease progression, unacceptable toxicities or patient refusal.


Fifty-two patients aged from 70 to 87 years were treated by FOLFIRINOX, 34 had colorectal cancer and 18 had pancreatic cancer. Most of them were in good general condition, 82.7% had a 0-1 performance status and 61.5% had a Charlson Comorbidity Index < 10. The most frequent severe toxicities were neutropenia (17 patients, n = 32.7%) and diarrhea (35 patients n = 67.3%); 10 of the case of neutropenia and 5 of diarrhea registered a grade 4 toxicity. Thirty-nine patients (75%) initially received an adapted dose of chemotherapy. The dosage was adjusted for 26% of patients during the course of treatment. Tumor response evaluated by RECIST criteria showed a controlled disease for 25 patients (48.1%), a stable disease for 13 and a partial response for 12 patients. Time under treatment was higher for colorectal cancer with a median time of 2.44 mo (95%CI: 1.61-3.25). Overall survival was 43.88 mo for colorectal cancer and 12.51 mo for pancreatic cancer. In univariate or multivariate analysis, none of geriatric parameters were linked to overall survival. Only the type of tumor (pancreatic/colorectal) was linked in both analysis.


For people over 70 years old, FOLFIRINOX regimen seems to induce manageable toxicities but similar, even higher, median survival rates compared to younger people.

Keywords: Elderly patients, Feasibility treatment, Pancreatic cancer, Colorectal cancer, FOLFIRINOX

Core tip: The incidence of cancer in patients over 70 years old is still increasing, especially for pancreatic and colorectal cancer. Database is missing concerning elderly patients, especially for considered aggressive chemotherapies, like FOLFIRINOX. The aim of this retrospective study was to show the feasibility of a combination chemotherapies (FOLFIRINOX) in an elderly population, by initially adapting the treatment dose, according to the patient’s general condition and comorbidities. We surprisingly observed prolonged survival and manageable toxicity levels.