Full dose neoadjuvant FOLFIRINOX is associated with prolonged survival in patients with locally advanced pancreatic adenocarcinoma

Moh'D Khushman, Naomi Dempsey, Jennifer Cudris Maldonado, Arturo Loaiza-Bonilla, Michel Velez, Lauren Carcas, Daniel Dammrich, Jorge Hurtado-Cordovi, Ritesh Parajuli, Terri Pollack, Ana P. Harwood, Jessica Macintyre, Ching Wei D. Tzeng, Jaime R. Merchan, Maria H. Restrepo, Ikechukwu I. Akunyili, Afonso Ribeiro, Govindarajan Narayanan, Lorraine Portelance, Danny SleemanJoe U. Levi, Caio Max S Rocha Lima, Peter J. Hosein

Research output: Contribution to journalArticlepeer-review

55 Scopus citations

Abstract

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-naïve 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.

Original languageEnglish (US)
Pages (from-to)667-673
Number of pages7
JournalPancreatology
Volume15
Issue number6
DOIs
StatePublished - 2015

Keywords

  • Borderline resectable pancreatic cancer
  • Chemotherapy
  • FOLFIRINOX
  • Locally advanced pancreatic cancer
  • Neoadjuvant
  • Pancreatic adenocarcinoma

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

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