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FOLFIRINOX: Gives New Hope to Pancreatic Cancer Patients

In 2019, optimum cancer care requires state-of-the-art molecular diagnosis a solid knowledge base to interpret and apply results and a nearly constant awareness of changes on the horizon; the field is moving that quickly. Drug approvals are no longer based solely on large phase three trials. Instead, they use umbrella or basket trials in order to assure the right drug is given to the right patients quicker. Precision medicine is now part of standard practice. In addition, that comes with many new challenges. this raised important questions. How to deal with tumors diversity?

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According to the American Cancer Society, this year more people will die from pancreatic cancer than from breast, brain, ovarian, or prostate cancer. One reason it is so hard to treat is its resistance to typical chemotherapy. A surgical oncologist from West Virginia University is exploring if FOLFIRINOX a new combination of cancer drugs can make a difference with pancreatic cancer in patients whose cancer is too close to blood vessels to remove safely. Anatomy of where this cancer strikes located behind the liver right near several important blood vessels that the person cannot survive without. By using the cocktail found in FOLFIRINOX it is hoped it will shrink the tumor so it no longer rests on the important blood vessels so the tumor can then be removed. It is also hoped that this will also lead to longer survival rates after surgery; at present averages around eleven months (WVU, 2019).

Challenges
Most human cancers display high levels of heterogeneity(a quality or state of being diverse in character or content)and this feature creates a negative response to treatment. Pancreatic ductal cancer has a high mortality rate and has been found to be difficult to treat with chemotherapy. It is because of these qualities that researchers have devised a multidrug treatment that is called FOLFIRINOX. And while this combination has shown improvements in the survival rate, life expectancy to pancreatic cancer remains poor. Further study should focus on an association with recurrence-free survival and look at all other clinically relevant verities. FOLFIRINOX shows promise but must be studied further to provide more personalized treatment for these patients (Capurso & Sette, 2019).

Due to the elevated mortality rate of pancreatic cancer, accurate and early detection methods are in great demand. In this article, the researchers have followed the diagnosis, treatment and mortality journey of this woman. For her, the symptoms of pancreatic cancer presented as vague abdominal discomfort. This is one of the problems doctors have with this disorder. Typically patients present with abdominal discomfort and loss of weight. In addition, one study with 209 patients showed 0.9-3.6% of people presenting with acute pancreatitis, in reality, had pancreatic cancer. Something else came from a study of 50,000 patients was there is a significant relationship between the diagnosis of diabetes mellitus and pancreatic cancer within three years of diagnosis (Liu, Zeh & Boone, 2019).

There is Hope at Last
Majority of people diagnosed with pancreatic cancer have inoperable disease at that time. For that reason, systemic treatment is the cornerstone of therapy. In addition, there are more options for systemic therapy have now become available that were just a decade ago. This has lead to a bunch of unanswered questions and an urgent need for more clinical trials to come. Pancreatic cancer is an equal opportunity killer. About 4% of cancer-related deaths can be attributed to it. It is found more frequently diagnosed in older individuals and is rare to be diagnosed in someone under the age of 40. Unfortunately, only 20% of people realize they have pancreatic cancer that is still treatable and of those, the five-year survival rate is less than 5%. It has been projected that in the next 15 years that this will become the second leading cause of cancer deaths. With this in mind, even though much progress has been made there is still room for improvement. Presently patients with pancreatic cancer that is able to be removed, surgery is the only treatment. while there have been studies with adjuvant chemotherapy (given before surgery in the hope it will shrink the tumor away from blood vessels), what is currently available is toxic to the patient. In 2018 an article was written in the New England Journal of Medicine reporting that adjuvant therapy of modified FOLFIRINOX in these patients has shown significant promising results (Djanani et al, 2019).

Of the over 53,600 or so patients that will come for treatment of pancreatic cancer 30% will have borderline resectable (removable by surgery) growth. Even with surgical intervention and chemotherapy most only live approximately 11 months after diagnosis. This study looked at 141 patients with pancreatic cance3r that were chosen for testing and given FOLFIRINOX prior to surgery. Of that number, 110 were able to have their tumor removed as it had shrunk the tumor from 3.2 to 2.3. After surgery, the survival rate changes from 11 months before treatment to over three years after FOLFIRINOX treatment and surgery. This study did show that there is hope in including this kind of chemotherapy cocktail use prior to surgery. And even the National Cancer Databank noted an increase in survival time for those patients who receive presurgical therapy with this chemotherapy when compared to those patients who just had the tumor removed (Michelakos et al, 2019).

Conclusion
In Europe and the US, pancreatic cancer is currently the fourth cause of death. Despite different therapeutic strategies currently in use, the overall five-year survival remains around 8%. Adjuvant therapy-a treatment added to a curative treatment to prevent recurrence of clinical cancer from the microscopic residual disease. This step combined with surgery is being investigated for its effectiveness. One cocktail of chemotherapy agents FOLFIRNOX has shown promise with extending survival up to 24 months. Pancreatic cancer is a lethal disease with patient survival not changed in 40 years. And while FOLFIRNOX is showing promise protocols and benefits at different disease stage is still under investigation (Zumbo & Giovinazzo, 2019).

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Work Cited
Capurso, G & Sette, C. (2019). Drug resistance in pancreatic cancer: New player caught in the act. EBioMedicine, 40.

Djanani, A. et al. (2019). Management of ductal pancreatic cancer. European Surgery, 51(3).

Janssen, Q.P. et al. (2019). Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer: A systematic review and patient level meta-analysis. Journal of National Cancer Institute.

Liu, A., Zeh, H.J. & Boone, BA. (2019). Pancreatic cancer presenting as pancreatic duct disruption. Case Reports in Surgery. Hindawi.

Michelakos, T. et al. (2019). Predictors of resectability and survival in patients with borderline and locally advanced pancreatic cancer who underwent neo-adjuvant treatment with FOLFIRINOX. Annals of Surgery, 269(4). Wolters Kluwer Health, Inc. pp 733-740.

WVU. (2019). West Virginia University researcher studies new treatment for pancreatic cancer. West Virginia University School of Medicine.

Zumbo, G. & Giovinazzo, F. (2019). Neoadjuvant treatment in pancreatic cancer: Where are we? EC Gastroenterology and Digestive System, 6(2).

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Pre-surgery treatment offers new hope for pancreatic cancer patients