[6][7] However, FOLFIRINOX is a potentially highly toxic combination of drugs with serious side effects, and only patients with good performance status are candidates for the regimen.
[6][8] Currently FOLFIRINOX is being used as a neoadjuvant therapy, meaning to downstage patients with "borderline and locally advanced" disease with the hope of rendering their tumors amenable to surgical resection.
[9] In 2013, the U.S. Food and Drug Administration approved protein-bound paclitaxel (also known as nab-paclitaxel, sold as Abraxane) used with gemcitabine.
[8] In the United Kingdom, the National Institute for Health and Care Excellence (NICE), in a draft guidance issued in 2014, rejected the use of Abraxane in treatment due to concerns of side effects, efficacy, and cost relative to Gemzar (gemcitabine).
This was in response to Celgene putting forward a Patient Access Scheme (PAS) proposal, which would bring down the cost of the drug.