Mashaal Dhir1, Mazen S Zenati2, Ahmad Hamad3, Aatur D Singhi4, Nathan Bahary5, Melissa E Hogg3, Herbert J Zeh3, Amer H Zureikat6,7. 1. Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA. 2. Department of Biostatistics and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA. 3. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 5. Department of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 6. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. zureikatah@upmc.edu. 7. Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. zureikatah@upmc.edu.
Abstract
BACKGROUND: Both FOLFIRINOX and gemcitabine/nab-paclitaxel (G-nP) are used increasingly in the neoadjuvant treatment (NAT) of pancreatic ductal adenocarcinoma (PDA). This study aimed to compare neoadjuvant FOLFIRINOX and G-nP in the treatment of resectable (R) and borderline resectable (BR) head PDA. METHODS: A single-institution retrospective review of R and BR patients undergoing pancreaticoduodenectomy after NAT with FOLFIRINOX or G-nP was performed. Comparative analysis was performed using inverse-probability-weighted (IPW) estimators. The end points of the study were overall survival (OS) and an 80% reduction in CA19-9 with NAT. RESULTS: In this study, 193 patients were analyzed, with 73 patients receiving FOLFIRINOX and 120 patients receiving G-nP. The median OS was 38.7 months for FOLFIRINOX versus 28.6 months for G-nP (p = 0.214). The patients who received FOLFIRINOX were younger and had fewer comorbidities, more BR disease, and larger tumors than those treated with G-nP (all p < 0.05). The two regimens were equally effective in achieving an 80% decline in CA19-9 (p = 0.8). The R0 resection rates were similar (80%), but FOLFIRINOX was associated with a reduction in pN1 disease (56% vs. 72%; p = 0.028). The receipt of adjuvant therapy was similar (74 vs. 75%; p = 0.79). In the Cox regression analysis with adjustment for baseline and treatment-related variables (FOLFIRINOX vs. G-nP, age, gender, computed tomography (CT) tumor size, BR vs. R, pre-NAT CA19-9), regimen type was not associated with a survival benefit. In the IPW analysis of 166 patients, however, the average treatment effect of FOLFIRINOX was to increase OS by 4.9 months compared with G-nP (p = 0.012). CONCLUSIONS: Both FOLFIRINOX and G-nP are viable options for neoadjuvant treatment of PDA. In this study, neoadjuvant FOLFIRINOX was associated with a 4.9-month improvement in survival compared with G-nP after adjustment for covariates.
BACKGROUND: Both FOLFIRINOX and gemcitabine/nab-paclitaxel (G-nP) are used increasingly in the neoadjuvant treatment (NAT) of pancreatic ductal adenocarcinoma (PDA). This study aimed to compare neoadjuvant FOLFIRINOX and G-nP in the treatment of resectable (R) and borderline resectable (BR) head PDA. METHODS: A single-institution retrospective review of R and BR patients undergoing pancreaticoduodenectomy after NAT with FOLFIRINOX or G-nP was performed. Comparative analysis was performed using inverse-probability-weighted (IPW) estimators. The end points of the study were overall survival (OS) and an 80% reduction in CA19-9 with NAT. RESULTS: In this study, 193 patients were analyzed, with 73 patients receiving FOLFIRINOX and 120 patients receiving G-nP. The median OS was 38.7 months for FOLFIRINOX versus 28.6 months for G-nP (p = 0.214). The patients who received FOLFIRINOX were younger and had fewer comorbidities, more BR disease, and larger tumors than those treated with G-nP (all p < 0.05). The two regimens were equally effective in achieving an 80% decline in CA19-9 (p = 0.8). The R0 resection rates were similar (80%), but FOLFIRINOX was associated with a reduction in pN1 disease (56% vs. 72%; p = 0.028). The receipt of adjuvant therapy was similar (74 vs. 75%; p = 0.79). In the Cox regression analysis with adjustment for baseline and treatment-related variables (FOLFIRINOX vs. G-nP, age, gender, computed tomography (CT) tumor size, BR vs. R, pre-NAT CA19-9), regimen type was not associated with a survival benefit. In the IPW analysis of 166 patients, however, the average treatment effect of FOLFIRINOX was to increase OS by 4.9 months compared with G-nP (p = 0.012). CONCLUSIONS: Both FOLFIRINOX and G-nP are viable options for neoadjuvant treatment of PDA. In this study, neoadjuvant FOLFIRINOX was associated with a 4.9-month improvement in survival compared with G-nP after adjustment for covariates.
Authors: A J Hyde; R Nassabein; A AlShareef; D Armstrong; S Babak; S Berry; D Bossé; E Chen; B Colwell; C Essery; R Goel; R Goodwin; S Gray; N Hammad; A Jeyakuymar; D Jonker; P Karanicolas; N Lamond; R Letourneau; J Michael; N Patil; E Powell; R Ramjeesingh; W Saliba; R Singh; S Snow; T Stuckless; S Tadros; M Tehfé; M Thana; M Thirlwell; M Vickers; K Virik; S Welch; T Asmis Journal: Curr Oncol Date: 2019-10-01 Impact factor: 3.677
Authors: Pranav Murthy; Mazen S Zenati; Amr I Al Abbas; Caroline J Rieser; Nathan Bahary; Michael T Lotze; Herbert J Zeh; Amer H Zureikat; Brian A Boone Journal: Ann Surg Oncol Date: 2019-12-02 Impact factor: 5.344