Systematic review of resection rates and clinical outcomes after FOLFIRINOX-based treatment in patients with locally advanced pancreatic cancer

Abstract

Background. FOLFIRINOX prolongs survival in patients with metastatic pancreatic cancer and may also benefit patients with locally advanced pancreatic cancer (LAPC). Furthermore, it may downstage a proportion of LAPC into (borderline) resectable disease, however data are lacking. This review assessed outcomes after FOLFIRINOX-based therapy in LAPC. Methods. The PubMed, EMBASE and Cochrane library databases were systematically searched for studies published to 31 August 2015. Primary outcome was the (R0) resection rate. Results. Fourteen studies involving 365 patients with LAPC were included; three studies administered a modified FOLFIRINOX regimen. Of all patients, 57 % (n = 208) received radiotherapy. The pooled resection rate was 28 % (n = 103, 77 % R0), with a perioperative mortality of 3 % (n = 2), and median overall survival ranged from 8.9 to 25.0 months. Survival data after resection were scarce, with only one study reporting a median overall survival of 24.9 months in 28 patients. A complete pathologic response was found in 6 of 85 (7 %) resected specimens. Dose reductions were described in up to 65 % of patients, grade 3-4 toxicity occurred in 23 % (n = 51) of patients, and 2 % (n = 5) had to discontinue treatment. Data of patients treated solely with FOLFIRINOX, without additional radiotherapy, were available from 292 patients: resection rate was 12 % (n = 29, 70 % R0), with 15.7 months median overall survival and 19 % (n = 34) grade 3-4 toxicity. Conclusions. Outcomes after FOLFIRINOX-based therapy in patients with LAPC seem very promising but further prospective studies are needed, especially with regard to survival after resection.Pancreatic ductal adenocarcinoma has very poor survival rates. Surgical resection with adjuvant chemotherapy offers the best survival but is only feasible in approximately 20 % of patients.

Impact of neoadjuvant therapy on postoperative outcomes after pancreaticoduodenectomy

“…One meta‐analysis found 43% of patients with borderline resectable and locally advanced disease were able to be resected after preoperative FOLFIRINOX with or without radiation, with a complete resection (R0) rate of 85% . Similarly, another systematic review of locally advanced pancreatic cancer patients found that 28% underwent resection after FOLFIRINOX with or without radiation, with a 77% R0 resection rate . Consistent with these prior studies, this study demonstrated that patients treated with neoadjuvant therapy had smaller tumors and fewer nodes positive on pathologic staging compared to patients treated with surgery first (see Table ), supporting the idea that neoadjuvant therapy results in downstaging of the tumor.…”

“…Neoadjuvant therapy is increasingly being utilized in borderline resectable and locally advanced pancreatic cancer to improve margin negative resection rates or increase resectability, particularly in high‐volume and academic centers . One meta‐analysis found 43% of patients with borderline resectable and locally advanced disease were able to be resected after preoperative FOLFIRINOX with or without radiation, with a complete resection (R0) rate of 85% .…”

Pancreatic Cancer Genomes: Implications for Clinical Management and Therapeutic Development

“…The evidence for platinum therapy in PDAC is ever increasing in the neoadjuvant, adjuvant and palliative settings (42)(43)(44)(45)(46)(47). Exceptional responders to platinum therapy are well documented, yet biomarkers of response require testing in prospective clinical trials (9,39).…”

Irreversible Electroporation of the Pancreas Using Parallel Plate Electrodes in a Porcine Model: A Feasibility Study

“…[1–5] Despite the improvement of survival rates after the advent of FOLFIRINOX, a combination chemotherapy, LAPC still has a poor prognosis. [6]Therefore, local ablative techniques are being explored as a new treatment options for LAPC, in the hope of substantial survival benefit. [7]…”