Hampig Kourie1, Edouard Auclin2, Antonio Sa Cunha3, Sebastien Gaujoux4, Mathieu Bruzzi5, Alain Sauvanet6, Nelson Lourenco7, Isabelle Trouilloud8, Samy Louafi9, Ahmad El-Hajjar10, Jean Christophe Vaillant11, Denis Smith12, Yann Touchefeu13, Jean-Baptiste Bachet14, Daniel Pietrasz15, Julien Taieb16. 1. Sorbonne Paris-Cité, Paris Descartes University, hepatogastroenterology and gastrointestinal oncology department, hôpital Européen Georges-Pompidou, 75015 Paris, France; Unité de génétique médicale, faculté de médecine, université Saint Joseph de Beyrouth, Beyrouth, Lebanon. 2. Unité de génétique médicale, faculté de médecine, université Saint Joseph de Beyrouth, Beyrouth, Lebanon; Methodology and quality of life unit in oncology, university hospital of Besançon, Besançon, France; Université Bourgogne Franche-Comté, Inserm, EFS BFC, UMR1098, interactions Hôte-Greffon-tumeur/ingenierie cellulaire et génique, 25000 Besançon, France. 3. Unité d'hospitalisation chirurgie hépatique, biliaire et pancréatique, centre hépato-biliaire, hôpital Paul-Brousse, faculté de médecine Paris-Sud, France. 4. Service de chirurgie digestive hépato-biliaire, pancréatique et endocrinienne, Hôpital Cochin, AP-HP, Paris, France. 5. Department of digestive and endocrine surgery, Saint-Louis hospital AP-HP, university Paris Diderot Sorbonne Paris Cite, Paris, France. 6. HPB surgery, Hopital Beaujon, AP-HP, university Paris VII, Clichy, France. 7. Versailles university, Boulogne-Billancourt, France. 8. Hôpital Saint-Antoine, 75012 Paris, France. 9. Sorbonne Paris-Cité, Paris Descartes University, hepatogastroenterology and gastrointestinal oncology department, hôpital Européen Georges-Pompidou, 75015 Paris, France; CH de longjumeau, France. 10. Sorbonne Paris-Cité, Paris Descartes University, hepatogastroenterology and gastrointestinal oncology department, hôpital Européen Georges-Pompidou, 75015 Paris, France. 11. AP-HP, Sorbonne Université, groupe hospitalier Pitié-Salpêtrère (AP-HP), Sorbonne Université, 75013 Paris, France. 12. Saint André Hospital, 1, rue Jean-Burguet, 33000 Bordeaux, France. 13. Institut des maladies de l'appareil digestif, gastrointestinal oncology unit, university hospital, 1, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France. 14. Service d'hépato-gastro-entérologie, groupe hospitalier Pitié Salpêtrière, 75013 Paris, France. 15. Department of digestive and hepatobiliary surgery, Pitié-Salpêtrière hospital, Sorbonne University, UPMC University, 75013, Paris, France. 16. Sorbonne Paris-Cité, Paris Descartes University, hepatogastroenterology and gastrointestinal oncology department, hôpital Européen Georges-Pompidou, 75015 Paris, France. Electronic address: jtaieb75@gmail.com.
Abstract
INTRODUCTION: Following publication of improved patients' outcome using first line FOLFIRINOX for metastatic pancreatic adenocarcinoma, many physicians now prescribe it as neo-adjuvant or induction treatment for borderline and locally advanced pancreatic cancer. A pathologic complete response, rarely seen with previous preoperative regimens, is sometimes observed in these patients. The aim of this study was to assess long-term outcomes of patients presenting pathologic complete response after preoperative FOLFIRINOX usually followed by chemo-radiation therapy for non-metastatic pancreatic adenocarcinoma. MATERIAL AND METHODS: We retrospectively identified all resected patients with pancreatic cancer presenting pathologic complete response after FOLFIRINOX in 9 French centers from the AGEO group between November 2010 and May 2017. RESULTS: 29 patients were enrolled, 14 had borderline, 14 locally advanced and 1 oligo-metastatic pancreatic cancer. M/F ratio was 1.2 and the mean age was 57 years. All patients were treated with FOLFIRINOX (n = 29), de-escalated to gemcitabine (n = 1) and FOLFIRI (n = 2), and 24 (83 %) received radiation therapy after chemotherapy. Objective response rate to preoperative chemotherapy was 66% (RECIST V1.1). Only 8 patients received postoperative chemotherapy. After a median follow-up of 34 months from surgery, the median overall survival was not reached and the median disease free survival was 48 months. The 1-year and 2-year survival rates were 100% for OS and 96% and 72 % for DFS from surgery, 8 of the 9 observed recurrences were distant metastases. CONCLUSIONS: The promising 1 and 2-year overall survival and disease free survival rates suggest that pathologic complete response is a major prognostic factor in resected pancreatic cancer following preoperative chemo-radiotherapy. A longer follow-up and prospective series are now necessary to confirm these encouraging results and to potentially validate pathologic complete response as a relevant surrogate marker of preoperative treatment efficacy.
INTRODUCTION: Following publication of improved patients' outcome using first line FOLFIRINOX for metastatic pancreatic adenocarcinoma, many physicians now prescribe it as neo-adjuvant or induction treatment for borderline and locally advanced pancreatic cancer. A pathologic complete response, rarely seen with previous preoperative regimens, is sometimes observed in these patients. The aim of this study was to assess long-term outcomes of patients presenting pathologic complete response after preoperative FOLFIRINOX usually followed by chemo-radiation therapy for non-metastatic pancreatic adenocarcinoma. MATERIAL AND METHODS: We retrospectively identified all resected patients with pancreatic cancer presenting pathologic complete response after FOLFIRINOX in 9 French centers from the AGEO group between November 2010 and May 2017. RESULTS: 29 patients were enrolled, 14 had borderline, 14 locally advanced and 1 oligo-metastatic pancreatic cancer. M/F ratio was 1.2 and the mean age was 57 years. All patients were treated with FOLFIRINOX (n = 29), de-escalated to gemcitabine (n = 1) and FOLFIRI (n = 2), and 24 (83 %) received radiation therapy after chemotherapy. Objective response rate to preoperative chemotherapy was 66% (RECIST V1.1). Only 8 patients received postoperative chemotherapy. After a median follow-up of 34 months from surgery, the median overall survival was not reached and the median disease free survival was 48 months. The 1-year and 2-year survival rates were 100% for OS and 96% and 72 % for DFS from surgery, 8 of the 9 observed recurrences were distant metastases. CONCLUSIONS: The promising 1 and 2-year overall survival and disease free survival rates suggest that pathologic complete response is a major prognostic factor in resected pancreatic cancer following preoperative chemo-radiotherapy. A longer follow-up and prospective series are now necessary to confirm these encouraging results and to potentially validate pathologic complete response as a relevant surrogate marker of preoperative treatment efficacy.
Authors: Dany Barrak; Anthony M Villano; Nicole Villafane-Ferriol; Leah G Stockton; Maureen V Hill; Mengying Deng; Elizabeth A Handorf; Sanjay S Reddy Journal: Eur J Surg Oncol Date: 2022-01-05 Impact factor: 4.037
Authors: Rebecca Y Kim; Kathleen K Christians; Mohammed Aldakkak; Callisia N Clarke; Ben George; Mandana Kamgar; Abdul H Khan; Naveen Kulkarni; William A Hall; Beth A Erickson; Douglas B Evans; Susan Tsai Journal: Ann Surg Oncol Date: 2020-09-30 Impact factor: 5.344
Authors: I Hartlapp; D Valta-Seufzer; J T Siveke; H Algül; E Goekkurt; G Siegler; U M Martens; D Waldschmidt; U Pelzer; M Fuchs; F Kullmann; S Boeck; T J Ettrich; S Held; R Keller; F Anger; C T Germer; A Stang; B Kimmel; V Heinemann; V Kunzmann Journal: ESMO Open Date: 2022-08-12