A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma
<p>Abstract</p> <p>Background</p> <p>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...
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| Format: | Article |
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BMC
2012-05-01
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| Series: | BMC Cancer |
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| Online Access: | http://www.biomedcentral.com/1471-2407/12/199 |
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| author | Hosein Peter J Macintyre Jessica Kawamura Carolina Maldonado Jennifer Ernani Vinicius Loaiza-Bonilla Arturo Narayanan Govindarajan Ribeiro Afonso Portelance Lorraine Merchan Jaime R Levi Joe U Rocha-Lima Caio M |
| author_facet | Hosein Peter J Macintyre Jessica Kawamura Carolina Maldonado Jennifer Ernani Vinicius Loaiza-Bonilla Arturo Narayanan Govindarajan Ribeiro Afonso Portelance Lorraine Merchan Jaime R Levi Joe U Rocha-Lima Caio M |
| author_sort | Hosein Peter J |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>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).</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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 %).</p> <p>Conclusions</p> <p>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.</p> |
| first_indexed | 2024-04-12T18:44:28Z |
| format | Article |
| id | doaj.art-95cf6be30806443aacfdb192023ea407 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-04-12T18:44:28Z |
| publishDate | 2012-05-01 |
| publisher | BMC |
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| series | BMC Cancer |
| spelling | doaj.art-95cf6be30806443aacfdb192023ea4072022-12-22T03:20:39ZengBMCBMC Cancer1471-24072012-05-0112119910.1186/1471-2407-12-199A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinomaHosein Peter JMacintyre JessicaKawamura CarolinaMaldonado JenniferErnani ViniciusLoaiza-Bonilla ArturoNarayanan GovindarajanRibeiro AfonsoPortelance LorraineMerchan Jaime RLevi Joe URocha-Lima Caio M<p>Abstract</p> <p>Background</p> <p>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).</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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 %).</p> <p>Conclusions</p> <p>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.</p>http://www.biomedcentral.com/1471-2407/12/199Pancreatic ductal carcinomaneoadjuvant therapysurgeryradiation therapy |
| spellingShingle | Hosein Peter J Macintyre Jessica Kawamura Carolina Maldonado Jennifer Ernani Vinicius Loaiza-Bonilla Arturo Narayanan Govindarajan Ribeiro Afonso Portelance Lorraine Merchan Jaime R Levi Joe U Rocha-Lima Caio M A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma BMC Cancer Pancreatic ductal carcinoma neoadjuvant therapy surgery radiation therapy |
| title | A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma |
| title_full | A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma |
| title_fullStr | A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma |
| title_full_unstemmed | A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma |
| title_short | A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma |
| title_sort | retrospective study of neoadjuvant folfirinox in unresectable or borderline resectable locally advanced pancreatic adenocarcinoma |
| topic | Pancreatic ductal carcinoma neoadjuvant therapy surgery radiation therapy |
| url | http://www.biomedcentral.com/1471-2407/12/199 |
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