BACKGROUND: The efficacy of FOLFIRINOX for metastatic pancreatic cancer has led to its use in patients with earlier stages of disease. This study retrospectively analyzed a cohort of patients with locally-advanced pancreatic cancer (LAPC) treated with FOLFIRINOX. METHODS: Between 2008 and 2013, 51 treatment-naïve patients with LAPC at a single institution received first-line FOLFIRINOX with neoadjuvant intent, at the full dose as described in the PRODIGE 4/ACCORD 11 study. Combined chemoradiation was administered for those who remained unresectable after maximum response to chemotherapy. The primary outcome measure was overall survival (OS), and secondary outcomes were progression-free survival (PFS) and margin-negative (R0) resection rate, and toxicity profile. RESULTS: A total of 429 cycles of FOLFIRINOX were given with a median of 8 cycles (range 2-29) per patient; 66% of cycles were full dose. After chemotherapy, 27 (53%) received chemoradiation. The median OS was 35.4 months (95% CI 25.8-45). Ten (4 borderline resectable and 6 unresectable) patients had successful R0 resections; those who had R0 resections had a significantly longer survival than those who did not (3-year OS rate 67% versus 21%, log rank p = 0.042). Increasing number of full-dose cycles was significantly associated with increased survival. The toxicity profile was similar to previous reports of this regimen. CONCLUSIONS: FOLFIRINOX is feasible as neoadjuvant therapy for LAPC. Although the R0 resection rate was only 20%, the median OS of almost 3 years appears promising. Dose intensity and duration were associated with increased survival in this study, arguing against dose attenuated versions of this regimen.
BACKGROUND: The efficacy of FOLFIRINOX for metastatic pancreatic cancer has led to its use in patients with earlier stages of disease. This study retrospectively analyzed a cohort of patients with locally-advanced pancreatic cancer (LAPC) treated with FOLFIRINOX. METHODS: Between 2008 and 2013, 51 treatment-naïve patients with LAPC at a single institution received first-line FOLFIRINOX with neoadjuvant intent, at the full dose as described in the PRODIGE 4/ACCORD 11 study. Combined chemoradiation was administered for those who remained unresectable after maximum response to chemotherapy. The primary outcome measure was overall survival (OS), and secondary outcomes were progression-free survival (PFS) and margin-negative (R0) resection rate, and toxicity profile. RESULTS: A total of 429 cycles of FOLFIRINOX were given with a median of 8 cycles (range 2-29) per patient; 66% of cycles were full dose. After chemotherapy, 27 (53%) received chemoradiation. The median OS was 35.4 months (95% CI 25.8-45). Ten (4 borderline resectable and 6 unresectable) patients had successful R0 resections; those who had R0 resections had a significantly longer survival than those who did not (3-year OS rate 67% versus 21%, log rank p = 0.042). Increasing number of full-dose cycles was significantly associated with increased survival. The toxicity profile was similar to previous reports of this regimen. CONCLUSIONS:FOLFIRINOX is feasible as neoadjuvant therapy for LAPC. Although the R0 resection rate was only 20%, the median OS of almost 3 years appears promising. Dose intensity and duration were associated with increased survival in this study, arguing against dose attenuated versions of this regimen.
Authors: Geoffrey M Kozak; Jeffrey D Epstein; Sandeep P Deshmukh; Benjamin B Scott; Scott W Keith; Harish Lavu; Charles J Yeo; Jordan M Winter Journal: J Gastrointest Surg Date: 2017-11-14 Impact factor: 3.452
Authors: Quisette P Janssen; Stefan Buettner; Mustafa Suker; Berend R Beumer; Pietro Addeo; Philippe Bachellier; Nathan Bahary; Tanios Bekaii-Saab; Maria A Bali; Marc G Besselink; Brian A Boone; Ian Chau; Stephen Clarke; Mary Dillhoff; Bassel F El-Rayes; Jessica M Frakes; Derek Grose; Peter J Hosein; Nigel B Jamieson; Ammar A Javed; Khurum Khan; Kyu-Pyo Kim; Song Cheol Kim; Sunhee S Kim; Andrew H Ko; Jill Lacy; Georgios A Margonis; Martin D McCarter; Colin J McKay; Eric A Mellon; Sing Yu Moorcraft; Ken-Ichi Okada; Alessandro Paniccia; Parag J Parikh; Niek A Peters; Hans Rabl; Jaswinder Samra; Christoph Tinchon; Geertjan van Tienhoven; Eran van Veldhuisen; Andrea Wang-Gillam; Matthew J Weiss; Johanna W Wilmink; Hiroki Yamaue; Marjolein Y V Homs; Casper H J van Eijck; Matthew H G Katz; Bas Groot Koerkamp Journal: J Natl Cancer Inst Date: 2019-08-01 Impact factor: 13.506
Authors: Masakazu Hashimoto; John David Konda; Stephanie Perrino; Maria Celia Fernandez; Andrew M Lowy; Pnina Brodt Journal: Mol Cancer Ther Date: 2021-09-22 Impact factor: 6.009