Better disease control rate and survival after FOLFIRINOX chemotherapy in patients with locally advanced pancreatic cancer compared to patients with metastatic disease

Abstract

Background: Outcomes of FOLFIRINOX chemotherapy in patients with locally advanced pancreatic cancer (LAPC) are scarce. Most literature is based on FOLFIRINOX response in metastatic patients only. This study aims to investigate if LAPC patients show better response and survival compared to patients with metastatic disease. Material & Methods: Patients who received FOLFIRINOX for pancreatic cancer (PDAC) within the Erasmus Medical Center until May 2018 were retrospectively identified. Objective response was evaluated with CT scans, using the RECIST criteria. The objective response rate (ORR) is calculated as the proportion of patients with complete (CR) or partial response (PR). The disease control rate (DCR) is calculated as the proportion of patients with CR, PR or stable disease. Results: From January 2012 to May 2018, 119 patients received FOLFIRINOX; 70 patients with LAPC and 49 with metastatic disease. 64/70 LAPC patients underwent diagnostic laparoscopy prior to chemotherapy to confirm the absence of metastases. The ORR was 25.8% in the LAPC group, 20.9% in the metastatic group (P=0.563). The DCR was 86.4% in the LAPC group, 65.1% in the metastatic group (P=0.009). The median progression free survival (PFS) was 10.7 months [95% CI 8.2-13.1] in the LAPC group and 7.0 months [95% CI 6.3-7.7] in the metastatic group (P=0.005). The median overall survival (OS) was 15.2 months [95% CI 11.5-18.9] in the LAPC group and 7.9 months [95% CI 5.2-10.5] in the metastatic group (P<0.001). LAPC responders showed a median OS of 22.2 months [95% CI 17.3-27.1], responders in the metastatic group 13.5 months [95% CI 9.6-17.4] (P=0.001). LAPC patients with progression under chemotherapy showed a median OS of 6.7 months [95% CI 3.1-10.4], metastatic patients with progression 4.9 months [95% CI 4.2-5.6] (P=0.041). Conclusion: LAPC patients treated with FOLFIRINOX show a higher DCR, PFS and OS compared to patients with metastatic disease.