While modified
FOLFIRINOX therapy is effective for treating advanced
pancreatic cancer, it frequently causes severe
neutropenia. The present study investigated the effect of severe
neutropenia on clinical outcomes in advanced
pancreatic cancer patients who received modified
FOLFIRINOX. The study subjects were 51 patients (30 males and 21 females) with advanced
pancreatic cancer who received modified
FOLFIRINOX (2h bolus injection of
oxaliplatin at 85 mg/m², 2 h bolus injection of L-
leucovorin at 200 mg/m², 90min bolus injection of
irinotecan at 150 mg/m², followed by continuous infusion of
5-fluorouracil for 46 h at 2400 mg/m² without bolus
5-fluorouracil) during the period from January 2014 to May 2018. No patients had prior history of
chemotherapy. Adverse events, including
neutropenia, were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. Median overall survival (OS) was the primary endpoint, while median
time to treatment failure (TTF), overall response rate (ORR), and the incidence of other adverse events were secondary endpoints. Severe
neutropenia (grade ≥3) occurred in 39 patients (76.4%), and Cox proportional hazard analysis identified high total
bilirubin level as a significant risk factor. Median duration of OS was significantly longer in patients with severe
neutropenia than in those without it (21.3 months versus 8.9 months, p = 0.020). Moreover, there was a significant correlation between OS and the grade of
neutropenia (r = 0.306, p = 0.029). ORR tended to be higher, though not significantly, in patients with severe
neutropenia. In contrast, the incidence rates of other adverse events were not different between the two groups. Severe
neutropenia is an independent predictor of prognosis in advanced
pancreatic cancer patients received modified
FOLFIRINOX therapy.