Neoadjuvant FOLFIRINOX application in borderline resectable pancreatic adenocarcinoma: a retrospective cohort study

Alessandro Paniccia, Barish H Edil, Richard D Schulick, Joshua T Byers, Cheryl Meguid, Csaba Gajdos, Martin D McCarter, Alessandro Paniccia, Barish H Edil, Richard D Schulick, Joshua T Byers, Cheryl Meguid, Csaba Gajdos, Martin D McCarter

Abstract

5-Fluorouracile, oxaliplatin, irinotecan, and leucovorin (FOLFIRINOX) has not been extensively used in the neoadjuvant setting because of concerns with safety and toxicity. We evaluated our institutional experience with neoadjuvant FOLFIRINOX in borderline resectable pancreatic adenocarcinoma (BRPAC). The primary endpoints were completion of therapy to surgery and negative resection margin (R0) rate. Patients with BRPAC treated with neoadjuvant FOLFIRINOX were retrospectively analyzed. Between August 2011 and September 2013, 20 patients with BRPAC treated with neoadjuvant FOLFIRINOX were identified. Most patients (88.8%) completed FOLFIRINOX therapy and underwent resection. Abutment of venous structures was identified in 13 cases (72.2%), while short segment portal vein encasement in 3 cases (16.6%) with concomitant arterial involvement in 3 cases (16.6%). Isolated superior mesenteric artery abutment was identified in 2 cases (11.2%). Patients received a median of 4 cycles of FOLFIRINOX. There was 1 case of progression. Vascular resection was performed in 9 cases (52.9%). Preoperative radiation therapy was used in 8 patients (44%). All patients underwent margin negative resection (R0). Histopathologic treatment response was evident in 10 cases (58.8%). Neoadjuvant FOLFIRINOX was generally safe and the expected toxicity did not prevent surgery allowing for a high rate of R0 resection.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Distribution of PADC between July 2011 and August 2013 based on resectability and treatment allocation. PADC = pancreatic adenocarcinoma.
FIGURE 2
FIGURE 2
Progression-free survival from first dose of chemotherapy administration.
FIGURE 3
FIGURE 3
Progression-free survival stratified by histopathologic response to neoadjuvant treatment. Grade 3: no response; Grades 1 and 2: partial response.
FIGURE 4
FIGURE 4
Overall survival from first dose of neoadjuvant treatment for all patients.

References

    1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. Cancer J Clin 2013; 63:11–30.
    1. Cameron JL, Pitt HA, Yeo CJ, et al. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993; 217:430–435.
    1. Orr RK. Outcomes in pancreatic cancer surgery. Surg Clin North Am 2010; 90:219–234.
    1. American Cancer Society. Cancer Facts and Figures 2013. Atlanta: American Cancer Society. 2013; . Accessed March 3, 2014.
    1. Vincent A, Herman J, Schulick R, et al. Pancreatic cancer. Lancet 2011; 378:607–620.
    1. Callery MP, Chang KJ, Fishman EK, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 2009; 16:1727–1733.
    1. Konstantinidis IT, Warshaw AL, Allen JN, et al. Pancreatic ductal adenocarcinoma. Ann Surg 2013; 257:731–736.
    1. Tucker ON, Rela M. Controversies in the management of borderline resectable proximal pancreatic adenocarcinoma with vascular involvement. HPB Surg 2008; 2008:1–8.
    1. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology (NCCN Guidelines). Pancreatic Adenocarcinoma. 2014; . Accessed March 3, 2014.
    1. Raut CP, Tseng JF, Sun CC, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg 2007; 246:52–60.
    1. Wilet CG, Lewandrowski K, Warshaw AL, et al. Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy. Ann Surg 1993; 217:144–148.
    1. Gillen S, Schuster T, Meyer zum Büschenfelde C, et al. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 2010; 7:e1000267.
    1. Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011; 364:1817–1825.
    1. Christians KK, Tsai S, Mahmoud A, et al. Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer: a new treatment paradigm? Oncologist 2014; 19:266–274.
    1. National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) v4.03. 2010; . Accessed February 10, 2014.
    1. Katz MHG, Fleming JB, Bhosale P, et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 2012; 118:5749–5756.
    1. Washington K, Berli J, Branton P, et al. Protocol for the Examination of Specimens From Patients With Carcinoma of the Exocrine Pancreas. College of American Pathologists (CAP) 2012. 2012; . Accessed March 1, 2014.
    1. Faris JE, Blaszkowsky LS, McDermott S, et al. FOLFIRINOX in locally advanced pancreatic cancer: the Massachusetts General Hospital Cancer Center experience. Oncologist 2013; 18:543–548.
    1. Boone BA, Steve J, Krasinskas AM, et al. Outcomes with FOLFIRINOX for borderline resectable and locally unresectable pancreatic cancer. J Surg Oncol 2013; 108:236–241.
    1. Hosein PJ, Macintyre J, Kawamura C, et al. A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma. BMC Cancer 2012; 12:199.
    1. Clinical . Neoadjuvant FOLFIRINOX regimen in patients with non-metastatic pancrease cancer. 2013; . Accessed March 1, 2014.
    1. Varadhachary GR, Tamm EP, Abbruzzese JL, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 2006; 13:1035–1046.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren