TY - JOUR
T1 - Full dose neoadjuvant FOLFIRINOX is associated with prolonged survival in patients with locally advanced pancreatic adenocarcinoma
AU - Khushman, Moh'D
AU - Dempsey, Naomi
AU - Cudris Maldonado, Jennifer
AU - Loaiza-Bonilla, Arturo
AU - Velez, Michel
AU - Carcas, Lauren
AU - Dammrich, Daniel
AU - Hurtado-Cordovi, Jorge
AU - Parajuli, Ritesh
AU - Pollack, Terri
AU - Harwood, Ana P.
AU - Macintyre, Jessica
AU - Tzeng, Ching Wei D.
AU - Merchan, Jaime R.
AU - Restrepo, Maria H.
AU - Akunyili, Ikechukwu I.
AU - Ribeiro, Afonso
AU - Narayanan, Govindarajan
AU - Portelance, Lorraine
AU - Sleeman, Danny
AU - Levi, Joe U.
AU - Rocha Lima, Caio M.S.
AU - Hosein, Peter J.
N1 - Publisher Copyright:
© 2015 IAP and EPC.
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
KW - Borderline resectable pancreatic cancer
KW - Chemotherapy
KW - FOLFIRINOX
KW - Locally advanced pancreatic cancer
KW - Neoadjuvant
KW - Pancreatic adenocarcinoma
UR - http://www.scopus.com/inward/record.url?scp=84962208346&partnerID=8YFLogxK
U2 - 10.1016/j.pan.2015.08.010
DO - 10.1016/j.pan.2015.08.010
M3 - Article
C2 - 26412296
AN - SCOPUS:84962208346
SN - 1424-3903
VL - 15
SP - 667
EP - 673
JO - Pancreatology
JF - Pancreatology
IS - 6
ER -