Maximilian Weniger1, John Moir2, Marko Damm3, Laura Maggino4, Maximilian Kordes5, Jonas Rosendahl3, Güralp O Ceyhan6, Stephan Schorn7. 1. Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilians University, Munich, Germany. 2. Departments of Hepatopancreatobiliary and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, UK. 3. Department of Gastroenterology, University Hospital Halle/Saale, Halle, Germany. 4. Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy. 5. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 6. Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany; Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey. Electronic address: gueralp.ceyhan@tum.de. 7. Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Abstract
BACKGROUND: Neoadjuvant chemotherapy has become a powerful tool to convert borderline resectable (BRPC) and locally advanced pancreatic cancers (LAPC) into a resectable scenario. However, data analyzing the optimal type of therapy are scarce. In the present multicenter retrospective study, we evaluated the influence of FOLFIRINOX (FFX) and gemcitabine (GEM)-based neoadjuvant therapy on patient prognosis. METHODS: Data on 239 patients from 7 centers across Europe was gathered using an online database. Patients having received their first cycle of chemotherapy for BRPC/LAPC before 06/2017, with a minimum follow-up of 12 months, were included in the intention-to-treat analysis. RESULTS: Patients treated with neoadjuvant FFX (n = 135) or gemcitabine + nab-paclitaxel (GNP) (n = 38) had significantly improved radiological response according to RECIST criteria as compared to single-agent GEM (n = 16), with a partial/complete response of 59.3%, 55.3% and 6.25% respectively (p = 0.001). Treatment with FFX (n = 135) and GNP (n = 38) resulted in higher resection rates compared to GEM (73.3%, 81.6% and 43.8%; p = 0.01 and p = 0.005). Regardless of regimen, patients who were resected had significantly prolonged overall survival compared to non-resected patients (p < 0.01). Complete pathological responses (ypT0 ypN0) were predominantly observed with FFX (p = 0.01). Adjuvant GNP in addition to successful neoadjuvant therapy and surgery resulted in a trend towards improved median survival as compared to postoperative observation (47.0 vs. 30.1 months, p = 0.06). CONCLUSIONS: Representing one of the largest studies published so far, our results reveal that patients with BRPC/LAPC should be offered either FFX or GNP to improve chances of resection and with this also survival.
BACKGROUND: Neoadjuvant chemotherapy has become a powerful tool to convert borderline resectable (BRPC) and locally advanced pancreatic cancers (LAPC) into a resectable scenario. However, data analyzing the optimal type of therapy are scarce. In the present multicenter retrospective study, we evaluated the influence of FOLFIRINOX (FFX) and gemcitabine (GEM)-based neoadjuvant therapy on patient prognosis. METHODS: Data on 239 patients from 7 centers across Europe was gathered using an online database. Patients having received their first cycle of chemotherapy for BRPC/LAPC before 06/2017, with a minimum follow-up of 12 months, were included in the intention-to-treat analysis. RESULTS:Patients treated with neoadjuvant FFX (n = 135) or gemcitabine + nab-paclitaxel (GNP) (n = 38) had significantly improved radiological response according to RECIST criteria as compared to single-agent GEM (n = 16), with a partial/complete response of 59.3%, 55.3% and 6.25% respectively (p = 0.001). Treatment with FFX (n = 135) and GNP (n = 38) resulted in higher resection rates compared to GEM (73.3%, 81.6% and 43.8%; p = 0.01 and p = 0.005). Regardless of regimen, patients who were resected had significantly prolonged overall survival compared to non-resected patients (p < 0.01). Complete pathological responses (ypT0 ypN0) were predominantly observed with FFX (p = 0.01). Adjuvant GNP in addition to successful neoadjuvant therapy and surgery resulted in a trend towards improved median survival as compared to postoperative observation (47.0 vs. 30.1 months, p = 0.06). CONCLUSIONS: Representing one of the largest studies published so far, our results reveal that patients with BRPC/LAPC should be offered either FFX or GNP to improve chances of resection and with this also survival.
Authors: Thomas F Stoop; Eran van Veldhuisen; L Bengt van Rijssen; Remy Klaassen; Oliver J Gurney-Champion; Ignace H de Hingh; Olivier R Busch; Hanneke W M van Laarhoven; Krijn P van Lienden; Jaap Stoker; Johanna W Wilmink; C Yung Nio; Aart J Nederveen; Marc R W Engelbrecht; Marc G Besselink Journal: Langenbecks Arch Surg Date: 2022-10-15 Impact factor: 2.895
Authors: Logan R McNeil; Alex B Blair; Robert W Krell; Chunmeng Zhang; Aslam Ejaz; Vincent P Groot; Georgios Gemenetzis; James C Padussis; Massimo Falconi; Christopher L Wolfgang; Matthew J Weiss; Chandrakanth Are; Jin He; Bradley N Reames Journal: Surg Open Sci Date: 2022-08-06