Intensification of induction chemotherapy before consolidation chemoradiotherapy improves progression-free survival and time without treatment in patients with locally advanced pancreatic cancers
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Nicolas Williet1,2, Thomas Di Bernardo1, Chloé Vernet1, Léa Saban Roche3, Thierry Muron3, Xavier Roblin1, Nicolas Magne4 and Jean-Marc Phelip1,2
1Hepatogastroenterology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
2EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
3Medical Oncology Department, Institut Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
4Radiotherapy Department, Institut Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
Nicolas Williet, email: firstname.lastname@example.org
Keywords: induction chemotherapy; locally advanced; pancreatic carcinoma; radiotherapy; survival
Received: June 02, 2018 Accepted: July 21, 2018 Published: August 10, 2018
Aims: To assess the interest of induction chemotherapy (ICT) intensification before chemoradiotherapy (CRT) in patients with locally advanced pancreatic cancer.
Methods: Charts of patients treated between February 2010 and November 2016 with consolidation capecitabin based-CRT were retrospectively reviewed in this bicentric study. Patients who underwent Gemcitabine as ICT (Group G) were compared to patients treated with intensive ICT (group I). Primary objectives were progression-free survival (PFS), defined as the time from the first day of ICT to progression or last follow-up, and Time without treatment (TWT), as the time from the last day of CRT to progression.
Results: Patients’ characteristics were balanced between group I (Folforinox: n = 24; GemOx: n = 6) and group G (n = 16) including mean age (63.7 vs 68.1 years), and performance status (PS 0-1 :90% vs 93.7%). Median PFS (17.8 months vs 12 months; p = 0.02) and TWT (7.4 months vs 2.5 months p = 0.01) were statistically better in group I vs group G. These results remained statistically and clinically significant by comparing Folfirinox subgroup to Gemcitabine. A trend to a better median overall survival was observed in group I (20.4 months) vs group G (18.3 months; p = 0.07). After adjusting for ICT duration, PS, and CA19.9 level, ICT intensification remains independently prognostic. Toxicity profile was in accordance with Literature.
Conclusion: This study shows ICT intensification before CRT is an interesting approach in patients with locally advanced pancreatic cancer. Further studies are needed to confirm these results, and to assess the specific role of CRT in this setting.
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