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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.
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.
DNA crosslinking (oxaliplatin), topoisomerase-I inhibition (irinotecan), antimetabolite (5-FU with leucovorin modulation).
1.FOLFIRINOX / mFOLFIRINOX slips into a pocket on its target.
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| Region | Year | Indication |
|---|---|---|
| Global | 2011 | Metastatic PDAC (PRODIGE 4 / ACCORD 11; component drugs generic) |
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Together with NORPACT-1 this left the neoadjuvant question for resectable disease open: FOLFIRINOX before surgery is not proven superior to alternatives, and the comparison against upfront surgery with adjuvant modified FOLFIRINOX is what PREOPANC-3 and Alliance A021806 are running.
The strongest human evidence that a cancer vaccine can make durable T cells in a tumour with few mutations; the randomised phase 2 IMCODE003 (260 patients, primary completion listed for January 2031) is the test of whether that translates into fewer relapses.
Upfront surgery followed by adjuvant chemotherapy remains standard for clearly resectable pancreatic cancer; neoadjuvant treatment belongs in trials or borderline disease.
ESPAC5 supports neoadjuvant chemotherapy over immediate surgery in borderline resectable disease and points to FOLFIRINOX as the regimen to build on.
Neoadjuvant modified FOLFIRINOX without routine radiotherapy became the reference approach for borderline resectable disease in North America; radiotherapy is reserved for selected patients or trials.
The best survival ever recorded in a pancreatic cancer trial, and the benchmark every perioperative trial (PREOPANC-3, Alliance A021806) and every adjuvant RAS inhibitor or vaccine trial (RASolute 304, IMCODE003) now has to beat or add to.
The second total neoadjuvant therapy schedule to change practice, and the one that shows the advantage is partly deliverability: chemotherapy given before an operation is completed by far more patients than chemotherapy given after one.
It is the number behind 'basal-like is chemoresistant' and the validation of the GATA6 stain that lets a pathology laboratory call the subtype without RNA sequencing.
Query for this drug: (TITLE:"FOLFIRINOX / mFOLFIRINOX" OR ABSTRACT:"FOLFIRINOX / mFOLFIRINOX") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about FOLFIRINOX / mFOLFIRINOX, not a curated reading list.
Shares 24BRO681 : Alternating Gnp and mFOLFIRINOX for BR-PDAC, LAPIS, NEOLAP, Surufatinib in Combination With Iparomlimab and Tuvonralimab Injection and AG Chemotherapy for Neoadjuvant Therapy of HRPC or BRPC.
Shares Living with FOLFIRINOX, NALIRIFOX and gemcitabine with nab-paclitaxel, Basal-like PDAC Treated With Gemcitabine, Erlotinib, and Nab-paclitaxel, Adenosquamous carcinoma of the pancreas, NAPOLI 3.
Shares NEOLAP, SWOG S1505, CONKO-007, Alliance A021501.
Shares PREOPANC-3, Alliance A021806, PREOPANC-2, NORPACT-1.
Shares Genomic methods identify homologous recombination deficiency in pancreas adenocarcinoma and optimize treatment selection, RNA neoantigen vaccines prime long-lived CD8+ T cells in pancreatic cancer, Pancreatic acinar cell carcinoma, Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma.
Shares PRODIGE 24/CCTG PA6: adjuvant modified FOLFIRINOX versus gemcitabine after resection of pancreatic cancer, PRODIGE 4 / ACCORD 11, Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23), Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial.
Shares Study to Evaluate the Safety, Tolerability & Efficacy of TNG462 in Combination in PDAC & NSCLC Patients, RAS(ON) inhibitors to convert unresectable pancreatic cancer to resectable, Pancreatic cancer drugs in England: NICE appraisals and the Cancer Drugs Fund (September 2026), RAS inhibitor combinations and sequence: pan-RAS plus G12D-selective, plus chemotherapy, and what to give after progression.
Shares AVENGER 500, LAPIS, CONKO-007, Alliance A021501.