Background: Radiation-induced necrosis is a complication of brain irradiation. Treatment options are limited. Methods: The response to treatment with low-dose bevacizumab in 2 patients with radiation-induced necrosis was reported. Results: Both patients with metastatic melanoma, aged 48 and 51 years, had significant symptomatic and radiological improvement with low-dose bevacizumab treatment. Doses as low as 5 mg/kg every 6 weeks and 7.5 mg/kg i.v. every 4 weeks were used and were highly effective. Conclusions: Low-dose bevacizumab is a solid option in the management of edema associated with radiation necrosis.

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e15176 Background: Few data regard efficacy and safety of FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, fluorouracil bolus of 400 mg/m2 and continuous infusion of 2400 mg/m2 over 46 hours and leucovorin 400 mg/m2) in patients over 65 years with advanced pancreatic adenocarcinoma. Methods: After Ethical Committee approval, consecutive patients age over 65 with biopsy proven pancreatic adenocarcinoma that received at least one cycle of modified dose-attenuated FOLFIRINOX (no bolus FU and reduced dose of at least one agent since first cycle) were selected (São José Hospital database) for a retrospective review for safety, response, and survival. Results: Nineteen consecutive patients were selected from our database. Patients characteristics included 12 (63,1%) males, 7 (36,9 %) females, median age 72,7 (range 66-79). Tumor location was 11 (57,8 %) head of the pancreas, 6 (31,57 %) body and 2 (11 %) in other sites. Grade 3/4 toxicities were reported in 10 patients (52,6 %): nausea/vomiting 1 (5,2 %), diarrhea 1 (5,2 %), fatigue 3 (15,7%), neutropenia 4 (21 %), thrombocytopenia 1 (5,2%) and febrile neutropenia 3 (15,6 %). Elevations in AST and ALT above the upper limit of normality were identified in 5 (26,31%). No deaths reported due to toxicity. Prophylactic granulocyte colony stimulator factor (G-CSF) was given to 14 (73 %). Seventeen patients completed at least four cycles; disease control was obtained in 15 (83, 3 %) with 1 complete response, 5 partial response and 9 stable diseases. Median reductions in doses in the first cycle of chemotherapy by drugs were: oxaliplatin 23,3 % (10%-30%), irinotecan 24,6 % (0%-60%), fluorouracil 20,6% (0%-40%). Median reductions in doses in the fourth cycle of chemotherapy by drugs were: oxaliplatin 20,8 % (0%-42%), irinotecan 24,9 % (0%-75%), fluorouracil 17,6% (0%-40%).With a median follow up of 4.5 months, median overall or progression free survival is not reached. Conclusions: Modified dose-attenuated FOLFIRINOX is a therapeutic option to elderly with advanced pancreatic adenocarcinoma. Although grade 3 and 4 toxicities were reported, they were manageable. Modified attenuated-dose of FOLFIRINOX needs further investigated.

468 Background: There is only limited data regarding efficacy and safety of FOLFIRINOX in elderly patients with advanced pancreatic adenocarcinoma. We aim to evaluate our experience with dose-reduced FOLFIRINOX in patients > 65 years-old. Methods: All patients > 65 years-old with biopsy-proven advanced pancreatic adenocarcinoma who received at least one cycle of modified dose-attenuatedFOLFIRINOX (no bolus FU and reduced dose of oxaliplatin and/or irinotecan) at our institution were identified. Results: Twenty-one consecutive patients (62% males) were reviewed. Median age was 67 (range 65-79). Grade 3/4 toxicities were reported in 7 (33%) patients ; the most common toxicities were anemia (62%), and nausea/vomiting (45%). Elevations in AST and/or ALT above the upper limit of normality were identified in 38%. No deaths due to toxicities were reported. Prophylactic granulocyte colony stimulator factor (G-CSF) was given in 16 (70 %) patients. Dose reductions were substantial with median reductions of 27,8 % (range 15 - 50%) for 5-FU, 27,1% (range 6-50%) for oxaliplatin and 25% (range 12-75%) for irinotecan. Median overall survival (OS) was 11,8 months (95% CI 10,2 - 13,3). Median progression free survival (PFS) was 6,9 months (95% CI 5,3 - 8,5). Conclusions: Modified dose-attenuated FOLFIRINOX is a reasonable option for elderly patients with advanced pancreatic adenocarcinoma. Adverse events were manageable and no deaths due to toxicity were reported. Median OS and PFS were similar to the pivotal phase III trial, demonstrating that dose-attenuated FOLFIRINOX may be beneficial to elderly patients.