Full dose neoadjuvant FOLFIRINOX is associated with prolonged survival in patients with locally advanced pancreatic adenocarcinoma
| Autor: | Danny Sleeman, Michel Velez, Moh’d Khushman, Maria H. Restrepo, Caio Max S. Rocha Lima, Lorraine Portelance, Ching Wei D. Tzeng, Ikechukwu Immanuel Akunyili, Govindarajan Narayanan, Jennifer Cudris Maldonado, Naomi Dempsey, Peter J. Hosein, Jorge Hurtado-Cordovi, Terri Pollack, Ritesh Parajuli, Joe U. Levi, Jessica MacIntyre, Daniel Dammrich, Arturo Loaiza-Bonilla, Ana Paula P. Harwood, Lauren Carcas, Jaime R. Merchan, Afonso Ribeiro |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty FOLFIRINOX Endocrinology Diabetes and Metabolism medicine.medical_treatment Adenocarcinoma Internal medicine Pancreatic cancer Antineoplastic Combined Chemotherapy Protocols medicine Humans Neoadjuvant therapy Aged Retrospective Studies Chemotherapy Hepatology business.industry Gastroenterology Retrospective cohort study Middle Aged medicine.disease Pancreatic Neoplasms Log-rank test Regimen Chemotherapy Adjuvant Female business |
| Zdroj: | Pancreatology. 15:667-673 |
| ISSN: | 1424-3903 |
| DOI: | 10.1016/j.pan.2015.08.010 |
| Popis: | Background The efficacy of FOLFIRINOX for metastatic pancreatic cancer has led to its use in patients with earlier stages of disease. This study retrospectively analyzed a cohort of patients with locally-advanced pancreatic cancer (LAPC) treated with FOLFIRINOX. Methods Between 2008 and 2013, 51 treatment-naive patients with LAPC at a single institution received first-line FOLFIRINOX with neoadjuvant intent, at the full dose as described in the PRODIGE 4/ACCORD 11 study. Combined chemoradiation was administered for those who remained unresectable after maximum response to chemotherapy. The primary outcome measure was overall survival (OS), and secondary outcomes were progression-free survival (PFS) and margin-negative (R0) resection rate, and toxicity profile. Results A total of 429 cycles of FOLFIRINOX were given with a median of 8 cycles (range 2–29) per patient; 66% of cycles were full dose. After chemotherapy, 27 (53%) received chemoradiation. The median OS was 35.4 months (95% CI 25.8–45). Ten (4 borderline resectable and 6 unresectable) patients had successful R0 resections; those who had R0 resections had a significantly longer survival than those who did not (3-year OS rate 67% versus 21%, log rank p = 0.042). Increasing number of full-dose cycles was significantly associated with increased survival. The toxicity profile was similar to previous reports of this regimen. Conclusions FOLFIRINOX is feasible as neoadjuvant therapy for LAPC. Although the R0 resection rate was only 20%, the median OS of almost 3 years appears promising. Dose intensity and duration were associated with increased survival in this study, arguing against dose attenuated versions of this regimen. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect