mFOLFIRINOX

What is mFOLFIRINOX?

• mFOLFIRINOX = modified FOLFIRINOX, a dose-adjusted version of the FOLFIRINOX regimen.
• Used primarily in metastatic pancreatic adenocarcinoma and increasingly in adjuvant and locally advanced disease.
• The modification is made to improve tolerability while maintaining efficacy.

Drug Components

FOLFIRINOX (original):

1. FOL = Leucovorin (Folinic acid)
2. F = 5-Fluorouracil (5-FU) (bolus + continuous infusion)
3. IRIN = Irinotecan
4. OX = Oxaliplatin

Modified FOLFIRINOX (mFOLFIRINOX):

• Oxaliplatin: 85 mg/m² IV day 1
• Leucovorin: 400 mg/m² IV day 1
• Irinotecan: 150 mg/m² IV day 1 (reduced from 180 mg/m²)
• 5-FU continuous infusion: 2400 mg/m² over 46 hours
• ❌ 5-FU bolus omitted (to reduce myelosuppression, diarrhea, mucositis)

Cycle: Every 2 weeks

Indications

• Metastatic pancreatic adenocarcinoma (preferred in ECOG 0–1, good organ function).
• Adjuvant therapy post-pancreatectomy (PRODIGE 24/CCTG PA.6 trial showed survival benefit vs. gemcitabine).
• Sometimes considered in locally advanced unresectable pancreatic cancer.

Toxicities

• Myelosuppression: neutropenia, thrombocytopenia, anemia.
• GI toxicity: diarrhea, nausea, vomiting, mucositis.
• Neuropathy: oxaliplatin-induced (cold sensitivity, cumulative).
• Fatigue, alopecia.
• Infections (esp. febrile neutropenia).

mFOLFIRINOX reduces toxicity compared to full FOLFIRINOX while keeping efficacy strong.

Monitoring

• CBC, renal, and hepatic function before each cycle.
• Neuropathy assessment.
• Diarrhea management (loperamide, hydration).
• Consider G-CSF prophylaxis in high-risk patients.