A narrative review of Safety management of 1 L platinum-based chemotherapy and maintenance olaparib in BRCA mutated advanced pancreatic cancer

OBJECTIVE: We aimed to review the safety management and efficacy of a modified FOLFIRINOX regimen to help clinicians improve first-line platinum-based chemotherapy and maintenance olaparib to treat patients with advanced PC with BRCA mutations. BACKGROUND: FOLFIRINOX has relatively high efficacy among all the chemotherapy regimens for advanced pancreatic carcinoma (PC) patients. However, the combination of drugs is often associated with a high incidence of adverse reactions, and safety concerns are the primary reasons limiting its clinical use. In recent years, through the adjustment of drug dosage and administration route, the toxicity of FOLFIRINOX has been reduced while its clinical effect has been maintained. Also, the empirical use of prophylactics in the chemotherapy cycle can reduce chemotherapy-related serious adverse reactions. All these methods have established a good foundation for the maintenance of olaparib. METHODS: Pubmed, Embase, and the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) were searched using the terms’ pancreatic cancer’, ‘folfirinox’, ‘parp inhibitor’, ‘chemotherapy’, and ‘adverse reaction’ from 2005 through to March 2021. CONCLUSIONS: The historical evidence suggested that modified FOLFIRINOX and maintenance olaparib could significantly improve the therapeutic effect and reduce the toxicity. It also provides some insights for clinicians to choose the most suitable regimen for each patient.