Survival Outcomes Associated With Clinical and Pathological Response Following Neoadjuvant FOLFIRINOX or Gemcitabine/Nab-Paclitaxel Chemotherapy in Resected Pancreatic Cancer

Abstract

Objective: To compare the survival outcomes associated with clinical and pathological response in pancreatic ductal adenocarcinoma (PDAC) patients receiving neoadjuvant chemotherapy (NAC) with FOLFIRINOX (FLX) or gemcitabine/nab-paclitaxel (GNP) followed by curative-intent pancreatectomy. Background: Newer multiagent NAC regimens have resulted in improved clinical and pathological responses in PDAC; however, the effects of these responses on survival outcomes remain unknown. Methods: Clinicopathological and survival data of PDAC patients treated at 7 academic medical centers were analyzed. Primary outcomes were overall survival (OS), local recurrence-free survival (L-RFS), and metastasis-free survival (MFS) associated with biochemical (CA 19–9 decrease ≥50% vs <50%) and pathological response (complete, pCR; partial, pPR or limited, pLR) following NAC. Results: Of 274 included patients, 46.4% were borderline resectable, 25.5% locally advanced, and 83.2% had pancreatic head/neck tumors. Vein resection was performed in 34.7% and 30-day mortality was 2.2%. R0 and pCR rates were 82.5% and 6%, respectively. Median, 3-year, and 5-year OS were 32 months, 46.3%, and 30.3%, respectively. OS, L-RFS, and MFS were superior in patients with marked biochemical response (CA 19–9 decrease ≥50% vs <50%; OS: 42.3 vs 24.3 months, P < 0.001; L-RFS-27.3 vs 14.1 months, P = 0.042; MFS-29.3 vs 13 months, P = 0.047) and pathological response [pCR vs pPR vs pLR: OS- not reached (NR) vs 40.3 vs 26.1 months, P < 0.001; L-RFS-NR vs 24.5 vs 21.4 months, P = 0.044; MFS-NR vs 23.7 vs 20.2 months, P = 0.017]. There was no difference in L-RFS, MFS, or OS between patients who received FLX or GNP. Conclusion: This large, multicenter study shows that improved biochemical, pathological, and clinical responses associated with NAC FLX or GNP result in improved OS, L-RFS, and MFS in PDAC. NAC with FLX or GNP has similar survival outcomes.

Impact of Neoadjuvant Chemoradiation on Pathologic Response in Patients With Localized Pancreatic Cancer

“…In the current study, we observed a CR rate of 4% and rates did not differ based on the type of neoadjuvant therapy delivered. Our findings are very similar to rates of CR reported by the largest study to examine pathologic response after neoadjuvant therapy (3.9%) as well as other contemporary studies utilizing neoadjuvant 5-flourouracil, oxaliplatin, and irinotecan (FOLFIRINOX) or gemcitabine/nab-paclitaxelas induction therapy (range 1-4%) (26)(27)(28). A unique finding of this study is the observation that the prognostic value of response in the primary tumor must be considered in the context of the status of locoregional lymph nodes.…”

Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection

“…However, low-grade evidence shows that in resectable and borderline-resectable pancreatic cancer, neoadjuvant chemotherapy with gemcitabine/nab-paclitaxel achieves survival outcomes similar to those of FOLFIRINOX. Considering that gemcitabine/nab-paclitaxel is better tolerated than FOL-FIRINOX, this regimen could be conveniently employed in older patients with comorbidities [64][65][66].…”

Identification of prognosis-related genes and construction of multi-regulatory networks in pancreatic cancer microenvironment by bioinformatics analysis

“…of cure for pancreatic cancer patients is surgical resection [2]. For decades, despite the concerted efforts, the five-year survival rate remains dismal for all stages combined [1].…”