Early tumor shrinkage as a predictor of favorable outcomes in patients with advanced pancreatic cancer treated with FOLFIRINOX.

Yasuhiro Kaga,Taikan Yamamoto,Yasutsuna Sasaki,Yu Uto,Yutaro Kubota,Atsushi Hisamatsu,Yu Sunakawa,Kouji Kobayashi,Ken Shimada,Takashi Sekikawa,Teppei Tagawa,Toshikazu Ikusue,Kouichirou Miyashita,Wataru Ichikawa,Hirokazu Toshima

doi:10.18632/oncotarget.12007

Abstract

There are several reports on the correlation between early tumor shrinkage (ETS) or depth of response (DpR) and survival in chemotherapies for colorectal cancer; however, few studies have investigated it in pancreatic cancer. We therefore investigated whether the ETS will predict outcomes in 59 patients with advanced pancreatic cancer treated with FOLFIRINOX therapy. The association of ETS with progression-free survival (PFS) and overall survival (OS) was evaluated but also we addressed to the correlation between outcomes and DpR. ETS was defined as a reduction ≥ 20% of target lesions' diameters measured at 6 to 8 weeks from treatment start. DpR was percentage of maximal tumor shrinkage observed at the nadir diameter compared with baseline. Among 47 evaluable patients for the ETS, 12 (25.5%) patients experienced ETS. The ETS was significantly associated with better PFS (9.0 vs. 4.2 months) as well as OS (24.0 vs. 9.1 months); moreover, the association had a statistically significance for PFS but a strong trend for OS in multivariate analysis. The DpR was statistically significantly but weakly associated with OS. In conclusion, this is the first report that the early response to chemotherapy may predict favorable outcomes in patients with advanced pancreatic cancer treated with FOLFIRINOX therapy.

Highlights

Pancreatic cancer is the fourth leading cause of death from cancer over the world, which is usually a high grade of malignancy at the diagnosis and is one of intractable cancers [1]
The association of early tumor shrinkage (ETS) with progression-free survival (PFS) and overall survival (OS) was evaluated and we addressed to the correlation between outcomes and depth of response (DpR)
The DpR was statistically significantly but weakly associated with OS. This is the first report that the early response to chemotherapy may predict favorable outcomes in patients with advanced pancreatic cancer treated with FOLFIRINOX therapy

Summary

Introduction

Pancreatic cancer is the fourth leading cause of death from cancer over the world, which is usually a high grade of malignancy at the diagnosis and is one of intractable cancers [1]. It carries a severe prognosis, which 5-year survival rate was reported to be lower than 5% [1]. The morbidity of the disease is increasing in recent year; more than 30,000 people die of pancreatic cancer every year in Japan [2]. Advanced pancreatic cancer remains an incurable disease with few cure treatments. The RR, median progression-free survival (PFS), and overall survival (OS) were significantly better in patients receiving FOLFIRINOX therapy compared to patients receiving gemcitabine therapy (RR, 31.6% vs. 9.4%; median PFS, 6.4 months vs. 3.3 months, HR 0.47, 95% CI 0.37–0.59, P < 0.001; median OS, 11.1 months vs. 6.8 months, HR 0.57, 95% CI 0.45–0.73, P < 0.001)

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