Research Papers:
Efficacy and safety of neoadjuvant FOLFIRINOX for borderline resectable pancreatic adenocarcinoma: improved efficacy compared with gemcitabine-based regimen
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Abstract
Changhoon Yoo1,*, Jihoon Kang1,*, Kyu-Pyo Kim1, Jae-Lyun Lee1, Baek-Yeol Ryoo1, Heung-Moon Chang1, Sang Soo Lee2, Do Hyun Park2, Tae Jun Song2, Dong Wan Seo2, Sung Koo Lee2, Myung-Hwan Kim2, Jin-Hong Park3, Dae Wook Hwang4, Ki Byung Song4, Jae Hoon Lee4 and Song Cheol Kim4
1Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
4Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
*C. Yoo and J. Kang contributed equally to this work and should be considered co-first authors
Correspondence to:
Kyu-Pyo Kim, email: [email protected]
Song Cheol Kim, email: [email protected]
Keywords: pancreatic cancer, chemotherapy, neoadjuvant, FOLFIRINOX
Received: November 17, 2016 Accepted: February 06, 2017 Published: May 16, 2017
ABSTRACT
Borderline resectable pancreatic cancer (BRPC) is a potentially resectable disease but is associated with poorer survival compared to primary resectable disease. There has been no prospective trial that compare the efficacy of FOLFIRNOX and gemcitabine-based regimen for BRPC. Between February 2013 and December 2014, 18 patients with BRPC receiving FOLFIRINOX were reviewed retrospectively. For comparative analysis, data for all BRPC patients (n=18) in our previous phase 2 study of neoadjuvant fixed-dose rate-gemcitabine plus capecitabine were pooled. Patients received a median 6 cycles (range, 3-13) of FOLFIRINOX. Surgical resection was performed in 12 patients (67%) and R0 resection in 9 patients. Median progression-free survival (PFS) and overall survival (OS) were 16.8 (95% confidence interval [CI], 9.4-24.2) and 21.2 (95% CI, 14.2-28.2) months, respectively. Patients who underwent surgical resection showed significantly better PFS (p=0.01) and OS (p=0.003) than those unresected. In the exploratory analysis, patients receiving FOLFIRINOX showed significantly longer PFS compared to those receiving fixed-dose rate-gemcitabine plus capecitabine (median 16.8 months [95% CI, 9.4-24.2] vs. 6.5 months [1.6-11.3]; p = 0.04). There was a trend toward improved OS in patients who received FOLFIRINOX (median 21.2 months [95% CI, 14.2-28.2]) compared to those who received fixed-dose rate-gemcitabine plus capecitabine (13.6 months [11.8-15.4]; p=0.12). FOLFIRINOX was feasible and effective as neoadjuvant chemotherapy for patients with BRPC and may have improved efficacy compared to a gemcitabine-based regimen.
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