Role of FOLFIRINOX and chemoradiotherapy in locally advanced and borderline resectable pancreatic adenocarcinoma: update of the AGEO cohort

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.

Conflict of interest statement

E.A.: Travel expenses: Mundipharma. Lectures and educational activities: Sanofi Genzymes, Lilly-Oncology. J.T.: Consulting or advisory role: Roche, Merck KGaA, Darmstadt, Germany, Amgen, Celgene, Eli Lilly, Servier, Sirtex Medical, Merck Sharp & Dohme, Pierre Fabre. Speakers’ Bureau: Servier, Amgen, Roche/Genentech, Sanofi, Merck KGaA, Darmstadt, Germany, Eli Lilly, Merck Sharp & Dohme, Pierre Fabre. The other authors have nothing to declare.

Figures

Fig. 1. Study flowchart showing the treatments according to BRPA and LAPA populations.

BRPA borderline resectable pancreatic adenocarcinoma, LAPA locally advanced pancreatic adenocarcinoma, CRT chemoradiation therapy.

Fig. 2. Survival curves in the overall study population.

Kaplan–Meier curves displaying survival according to the treatment received (a OS, b PFS) and according to the BRPA/LAPA status (c OS, d PFS). BRPA borderline resectable pancreatic adenocarcinoma, LAPA locally advanced pancreatic adenocarcinoma. Number of patients at risk varies due to missing data.