{"entity":{"id":"folfirinox","kind":"drug","name":"FOLFIRINOX / mFOLFIRINOX","aka":[],"tldr":"FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.","summary":"Oxaliplatin, irinotecan, leucovorin, and 5-fluorouracil. PRODIGE 4/ACCORD 11 (2011): OS 11.1 vs 6.8 months versus gemcitabine in fit metastatic patients. Modified FOLFIRINOX (PRODIGE 24, 2018) became the adjuvant standard after resection with median OS ~54 months, and is the most used neoadjuvant regimen for borderline-resectable disease. Toxicity (neutropenia, diarrhoea, neuropathy) restricts it to ECOG 0-1 patients. NALIRIFOX (liposomal irinotecan) is a 2024 variant for metastatic disease.","status":"standard-of-care","asOf":"2026-09-06","wikipedia":"https://en.wikipedia.org/wiki/FOLFIRINOX","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/FOLFIRINOX"},{"label":"NICE NG85 recommendation 1.9.4","url":"https://www.nice.org.uk/guidance/ng85/chapter/Recommendations"},{"label":"Conroy et al., PRODIGE 4/ACCORD 11 (NEJM 2011)","url":"https://doi.org/10.1056/NEJMoa1011923"},{"label":"Conroy et al., PRODIGE 24 five-year outcomes (JAMA Oncology 2022)","url":"https://doi.org/10.1001/jamaoncol.2022.3829"}],"tags":[],"related":[],"cancers":["pancreatic","resectable-pdac","borderline-resectable-pdac","metastatic-pdac"],"sections":[],"technologies":["cytotoxic-chemotherapy","platinum","topoisomerase-inhibitors"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["prodige-24","napoli-3","nct06922591","nct07255404","prodige-4-accord-11","preopanc-2","preopanc-3","alliance-a021806","alliance-a021501","swog-s1505","neolap","conko-007","panoptimox-prodige-35","crossfire","avenger-500","norpact-1","espac-5"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Pancreatic cancer, UK status: NICE NG85 1.9.4 offers FOLFIRINOX to people with metastatic disease and ECOG performance status 0 to 1 (recorded as an off-label use in February 2018), and modified FOLFIRINOX is given as adjuvant treatment on PRODIGE 24 although NG85 (2018) predates that trial and names gemcitabine plus capecitabine. Regulator status: a combination of individually licensed generic medicines with no single marketing authorisation. Four months of FOLFIRINOX followed by fluorouracil and leucovorin maintenance is an accepted alternative to six months (PANOPTIMOX-PRODIGE 35)."],"modality":"Cytotoxic regimen","mechanism":"DNA crosslinking (oxaliplatin), topoisomerase-I inhibition (irinotecan), antimetabolite (5-FU with leucovorin modulation).","approvals":[{"region":"Global","year":2011,"indication":"Metastatic PDAC (PRODIGE 4 / ACCORD 11; component drugs generic)"}],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},"route":"/drugs/folfirinox/","neighbours":{"cancer":[{"id":"pancreatic-adenosquamous-carcinoma","kind":"cancer","name":"Adenosquamous carcinoma of the pancreas","route":"/cancers/pancreatic-adenosquamous-carcinoma/"},{"id":"ampullary","kind":"cancer","name":"Ampullary cancer (ampulla of Vater)","route":"/cancers/ampullary/"},{"id":"borderline-resectable-pdac","kind":"cancer","name":"Borderline resectable pancreatic ductal 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