Is FOLFIRINOX Better In Primary Resected Metastatic Pancreatic Cancer ?

Abstract

Objective: Pancreatic cancer is a very fatal disease and is estimated to be the second leading cause of cancer deaths in the USA in 2030. Chemotherapy is usually the most important treatment option in metastatic pancreatic ductal adenocarcinoma and is applied for palliative purposes. FOLFIRINOX, which is a multi-drug regimen, is an important treatment option in patients with good performance in order to overcome chemoresistance in this desmoplastic cancer. Surgery is the most important way to eliminate chemoresistance in pancreatic cancer. FOLFIRINOX is preferred in adjuvant therapy because the disease reoccurs even in patients who can undergo surgery and it gives better survival results than gemcitabine. There is data suggesting that patients with pancreatic ductal adenocarcinoma who underwent surgery for the primary lesion and subsequently metastasized may have a better response with the FOLFIRINOX regimen than patients with metastatic presentation (de novo metastatic). This retrospective study was planned to investigate the response of previously operated patients who developed metastases (surgical group) and those with metastatic disease at the time of diagnosis (de novo metastatic group) to the FOLFIRINOX regimen.
 Materials and Methods: 35 patients followed between 2013 and 2017 were included in the study and their medical records were examined.
 Results: Progression free survival of surgery group was median 10 months. De novo metastatic group progression free survival was median 6 months (table 2). Surgery group progression free survival was statistically significant longer than de novo metastatic group (p:0.033). Surgery group overall survival was 20 months. De novo metastatic group overall survival was 7 months. Surgery group overall survival was statistically significant longer than de novo metastatic group (p:0.020).
 Conclusion: According to the results of our study, FOLFIRINOX treatment is more effective in patients with pancreatic ductal adenocarcinoma who underwent surgery for a primary pancreatic tumor and then developed metastasis. Therefore, regardless of performance, administration of FOLFIRINOX may be appropriate in patients who have undergone surgery. In addition, surgical treatments can be applied to metastatic patients to reduce the disease burden, since better results are obtained in patients who have been operated for palliative purposes. Randomized studies with larger patient populations are needed to validate our results.