Edouard Auclin1,2, Lysiane Marthey3, Raef Abdallah3, Léo Mas4, Eric Francois5, Angélique Saint5, Antonio Sa Cunha6, Angélique Vienot7, Thierry Lecomte8, Vincent Hautefeuille9, Christelle de La Fouchardière10, Matthieu Sarabi10, Feryel Ksontini11, Julien Forestier12, Romain Coriat13, Emmanuelle Fabiano14, Florence Leroy15, Nicolas Williet16, Jean-Baptiste Bachet4, David Tougeron17, Julien Taieb18. 1. Department of Hepato-Gastroenterology and Gastrointestinal Oncology, Université de Paris, Paris Descartes University, Hôpital Européen Georges Pompidou, Paris, France. 2. Department of Medical and Thoracic Oncology, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France. 3. Department of Gastroenterology, Kremlin Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Sud University, Le Kremlin Bicêtre, France. 4. Department of Gastroenterology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. 5. Department of Oncology, Anticancer Center A Lacassagne, Nice, France. 6. Department of Digestive Surgery, Hôpital Paul Brousse, Villejuif, France. 7. Department of Oncology, Besançon University Hospital, Besançon, France. 8. Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Trousseau, Tours, France. 9. Department of Gastroenterology and Digestive Oncology, Amiens University Hospital, Amiens, France. 10. Department of Gastrointestinal Oncology, Centre Léon Bérard, Lyon, France. 11. Department of Oncology, Institute Salah-Azaïz, Tunis, Tunisia. 12. Department of Gastroenterology, Hôpital Edouard Herriot, Lyon, France. 13. Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. 14. Department of Radiotherapy, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France. 15. Department of GI Oncology, Institut Gustave Roussy, Villejuif, France. 16. Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France. 17. Department of Hepato-Gastroenterology, Poitiers University Hospital, University of Poitiers, Poitiers, France. 18. Department of Hepato-Gastroenterology and Gastrointestinal Oncology, Université de Paris, Paris Descartes University, Hôpital Européen Georges Pompidou, Paris, France. Jtaieb75@gmail.com.
Abstract
BACKGROUND: FOLFIRINOX has shown promising results in locally advanced (LAPA) or borderline resectable (BRPA) pancreatic adenocarcinoma. We report here a cohort of patients treated with this regimen from the AGEO group. METHODS: This is a retrospective multicentre study. We included all consecutive patients with non-pre-treated LAPA or BRPA treated with FOLFIRINOX. RESULTS: We included 330 patients (57.9% male, 65.4% <65 years, 96.4% PS <2). Disease was classified as BRPA in 31.1% or LAPA in 68.9%. Objective response rate with FOLFIRINOX was 29.5% and stable disease 51%. Subsequent CRT was performed in 46.4% of patients and 23.9% had curative intent surgery. Resection rates were 42.1% for BRPA and 15.5% for LAPA. Main G3/4 toxicities were fatigue (15%), neutropenia (12%) and neuropathy (G2/3 35%). After a median follow-up of 26.7 months, median OS (mOS) and PFS were 21.4 and 12.4 months, respectively. For patients treated by FOLFIRINOX alone, or FOLFIRINOX followed by CRT, or FOLFIRINOX + /- CRT + surgery, mOS was 16.8 months, 21.8 months and not reached, respectively (p < 0.0001). CONCLUSIONS: FOLFIRINOX for LAPA and BRPA seems to be effective with a manageable toxicity profile. These promising results in "real-life" patients now have to be confirmed in a Phase 3 randomised trial.
BACKGROUND: FOLFIRINOX has shown promising results in locally advanced (LAPA) or borderline resectable (BRPA) pancreatic adenocarcinoma. We report here a cohort of patients treated with this regimen from the AGEO group. METHODS: This is a retrospective multicentre study. We included all consecutive patients with non-pre-treated LAPA or BRPA treated with FOLFIRINOX. RESULTS: We included 330 patients (57.9% male, 65.4% <65 years, 96.4% PS <2). Disease was classified as BRPA in 31.1% or LAPA in 68.9%. Objective response rate with FOLFIRINOX was 29.5% and stable disease 51%. Subsequent CRT was performed in 46.4% of patients and 23.9% had curative intent surgery. Resection rates were 42.1% for BRPA and 15.5% for LAPA. Main G3/4 toxicities were fatigue (15%), neutropenia (12%) and neuropathy (G2/3 35%). After a median follow-up of 26.7 months, median OS (mOS) and PFS were 21.4 and 12.4 months, respectively. For patients treated by FOLFIRINOX alone, or FOLFIRINOX followed by CRT, or FOLFIRINOX + /- CRT + surgery, mOS was 16.8 months, 21.8 months and not reached, respectively (p < 0.0001). CONCLUSIONS: FOLFIRINOX for LAPA and BRPA seems to be effective with a manageable toxicity profile. These promising results in "real-life" patients now have to be confirmed in a Phase 3 randomised trial.
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