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. 2012 May 29:12:199.
doi: 10.1186/1471-2407-12-199.

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

Peter J Hosein  1 , Jessica Macintyre, Carolina Kawamura, Jennifer Cudris Maldonado, Vinicius Ernani, Arturo Loaiza-Bonilla, Govindarajan Narayanan, Afonso Ribeiro, Lorraine Portelance, Jaime R Merchan, Joe U Levi, Caio M Rocha-Lima
Affiliations

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

Peter J Hosein et al. BMC Cancer. .

Abstract

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-naïve 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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Figures

Figure 1
Figure 1
Patient flowchart for patients assessed as having unresectable disease (panel 1A, n = 14), and for those assessed as having borderline resectable disease (panel 1B).
Figure 2
Figure 2
Kaplan-Meier survival curves: Panel 2A - progression-free survival for all patients; Panel 2B – overall survival for all patients; Panel 2 C - progression-free survival stratified by resection status; Panel 2D – overall survival stratified by resection status.
See this image and copyright information in PMC

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