Delivering complex pancreatic cancer care locally: Five-year FOLFIRINOX outcomes from Northern Ireland.

Abstract

e16358 Background: Combination chemotherapy (FOLFIRINOX) improves survival in metastatic pancreatic cancer, with PRODIGE4/ACCORD11 reporting a median overall survival (OS) of 11.1 months. Real-world outcomes across all stages, particularly in regional centres, remain under-reported. This study evaluates five-year outcomes for patients receiving FOLFIRINOX in routine practice and compares them with historic trial benchmarks. Methods: A retrospective cohort analysis was conducted of 32 consecutive pancreatic cancer patients treated with FOLFIRINOX between 2020–2025 at a regional UK cancer centre. Demographic, clinical, and treatment variables were collected, including Eastern Cooperative Oncology Group (ECOG) performance status, stage, treatment intent, dose modifications, and survival. OS was calculated from diagnosis to death or last follow-up. Outcomes were descriptively compared with PRODIGE4/ACCORD11. Results: Median age was 67 years (range 49–78); 56% were female. ECOG performance status was favourable, with > 85% ECOG 0–1. Stage distribution was: stage 1–2 (22%), stage 3 (41%), stage 4 (37%). Dose modifications were frequent across the cohort. All patients received FOLFIRINOX as first-line systemic therapy. Several early-stage and locally advanced patients also underwent surgery, Stereotactic Ablative Body Radiotherapy (SABR), or Concurrent Chemo-Radiotherapy(CCRT) as part of multimodality management. Across the entire cohort, median OS was approximately 13 months. In the stage 4 subgroup, median OS was ~10 months, closely aligning with the 11.1 months OS reported in PRODIGE4/ACCORD11 despite broader eligibility and real-world heterogeneity. Patients with stage 1–3 disease receiving multimodality therapy demonstrated prolonged survival, with several alive at last follow-up. Conclusions: FOLFIRINOX delivered real-world survival outcomes comparable to historic phase III data, even within a regional centre and across a broader patient population. Integration of surgery, SABR, and CCRT supported favourable outcomes in earlier-stage disease. These findings highlight the feasibility of delivering complex pancreatic cancer care outside tertiary centres and support ongoing pathway optimisation and trial integration. Key clinical characteristics and outcomes of pancreatic cancer patients. Variable Result Median Age (Range) 67 (49-78) Gender 56% F , 44% M ECOG Performance status > 85% ECOG 0-1 Stage at diagnosis Stage 1-2: 22%Stage 3: 41%Stage 4: 37% Treatment intent Adjuvant: 22%Locally advanced: 41%Metastatic/Palliative: 37% Definitive local therapy Surgery: 12 patientsSABR: 7 patientsCCRT: 4 patientsNone: 9 patients Dose modifications 90% Median OS (all patients) ~ 13 months Median OS (stage 4) ~ 10 months Comparison with PRODIGE4/ACCORD11 Trial OS: 11.1months (metastatic)Real-World OS comparable despite broader eligibility