Living longer with pancreatic cancer: More than FOLFIRINOX?

Abstract

476 Background: Effective treatment for uresectable locally advanced pancreatic cancer (LAPC) or metastatic pancreatic cancer is limited and has a poor prognosis with a five year survival rate of 6.7%. FOLFIRINOX has been studied as a neoadjuvant therapy for LAPC and has a response rate of 32%. We set out to investigate which factors, if any, have a meaningful impact on time to disease progression within this cohort of patients. Methods: A retrospective chart review was conducted. All patients who recieved FOLFIRINOX at our institution from 2011-2014 were included. 16 of 19 had unresectable LAPC or metastatic disease at time of diagnosis. A few recieved FOLFIRINOX upon first progression after adjuvant therapy. Results: See Table. Conclusions: Novel approaches are being used to get patients to R0 resection if they have borderline resectable pancreatic cancer or unresectable LAPC consisting of combination chemotherapy followed by radiation. Metastatic patients or unresectable LAPC who do not undergo surgery have limited survival. Reviewing our data we found that the addition of radiation in the metastatic setting may impact time to progression as determined by RECIST criteria. Of the three patients who had the longest time to progression, two were metastatic and both underwent palliative RT to the primary pancreatic lesion. Incorporation of RT to the primary lesion upon completion of FOLFIRINOX therapy should be considered as an innovative approach to increase time to progression and potentially progression free survival and overall survival. Clinical trials randomizing selected patients with metastatic or unresected LAPC to FOLFIRINOX followed by RT versus no RT should be considered. [Table: see text]