A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma

被引:181
作者
Hosein, Peter J. [1 ]
Macintyre, Jessica [1 ]
Kawamura, Carolina [2 ]
Maldonado, Jennifer Cudris [1 ]
Ernani, Vinicius
Loaiza-Bonilla, Arturo [1 ]
Narayanan, Govindarajan [3 ]
Ribeiro, Afonso [4 ]
Portelance, Lorraine [5 ]
Merchan, Jaime R. [1 ]
Levi, Joe U. [6 ]
Rocha-Lima, Caio M. [1 ]
机构
[1] Univ Miami, Dept Med, Div Hematol Oncol, Sylvester Comprehens Canc Ctr, Miami, FL 33152 USA
[2] Hosp Sao Jose, Adv Oncol Ctr, Sao Paulo, Brazil
[3] Univ Miami, Dept Radiol, Sylvester Comprehens Canc Ctr, Miami, FL USA
[4] Univ Miami, Div Gastroenterol, Dept Med, Sylvester Comprehens Canc Ctr, Miami, FL USA
[5] Univ Miami, Dept Radiat Oncol, Sylvester Comprehens Canc Ctr, Miami, FL USA
[6] Univ Miami, Dept Surg, Sylvester Comprehens Canc Ctr, Miami, FL USA
关键词
Pancreatic ductal carcinoma; neoadjuvant therapy; surgery; radiation therapy; PHASE-II; GEMCITABINE; CANCER;
D O I
10.1186/1471-2407-12-199
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (FOLFIRINOX) is superior to gemcitabine in patients with metastatic pancreatic cancer who have a good performance status. We investigated this combination as neoadjuvant therapy for locally advanced pancreatic cancer (LAPC). Methods: In this retrospective series, we included patients with unresectable LAPC who received neoadjuvant FOLFIRINOX with growth factor support. The primary analysis endpoint was R0 resection rate. Results: Eighteen treatment-naive patients with unresectable or borderline resectable LAPC were treated with neoadjuvant FOLFIRINOX. The median age was 57.5 years and all had ECOG PS of 0 or 1. Eleven (61 %) had tumors in the head of the pancreas and 9 (50 %) had biliary stents placed prior to chemotherapy. A total of 146 cycles were administered with a median of 8 cycles (range 3-17) per patient. At maximum response or tolerability, 7 (39 %) were converted to resectability by radiological criteria; 5 had R0 resections, 1 had an R1 resection, and 1 had unresectable disease. Among the 11 patients who remained unresectable after FOLFIRINOX, 3 went on to have R0 resections after combined chemoradiotherapy, giving an overall R0 resection rate of 44 % (95 % CI 22-69 %). After a median follow-up of 13.4 months, the 1-year progression-free survival was 83 % (95 % CI 59-96 %) and the 1-year overall survival was 100 % (95 % CI 85-100 %). Grade 3/4 chemotherapy-related toxicities were neutropenia (22 %), neutropenic fever (17 %), thrombocytopenia (11 %), fatigue (11 %), and diarrhea (11 %). Common grade 1/2 toxicities were neutropenia (33 %), anemia (72 %), thrombocytopenia (44 %), fatigue (78 %), nausea (50 %), diarrhea (33 %) and neuropathy (33 %). Conclusions: FOLFIRINOX followed by chemoradiotherapy is feasible as neoadjuvant therapy in patients with unresectable LAPC. The R0 resection rate of 44 % in this population is promising. Further studies are warranted.
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页数:7
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