Abstract
We conducted an institutional study to compare the clinical and pathological efficacy between the neoadjuvant therapy (NAT)‐modified FOLFIRINOX (mFOLF) vs nanoparticle albumin–bound paclitaxel plus gemcitabine (nab‐P/G) for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients who completed resection. The study retrospectively enrolled patients with pathologically confirmed BRPC or LAPC from 2010 to 2018 at our institution. The survival rates were determined by the Kaplan‐Meier method and log‐rank test was used to test differences. Cox's proportional hazard model was used to assess survival with respect to covariates. Seventy‐two patients who completed at least two cycles of neoadjuvant chemotherapy and surgical resection were included, with 52 (72.2%) patients receiving mFOLF and 20 (27.8%) receiving nab‐P/G. Patients treated with mFOLF had statistically higher rates of RECIST 1.1 partial or complete response (16/52 vs 1/20, P = .028). Additionally, mFOLF patients had greater pathological tumor size reduction, fewer positive lymph nodes, and higher treatment response grade compared to the nab‐P/G patients (all P < .05). The median overall survival was 33.3 months vs 27.1 months (P = .105), and distant metastasis‒free survival (DMFS) was 21.3 months vs 14.6 months (P = .042) in the mFOLF vs nab‐P/G groups, respectively. On multivariate analysis, mFOLF (hazard ratio, 0.428; 95% confidence interval [CI], 0.186‐0.987) and abnormal postoperative CA 19‐9 (hazard ratio, 2.47; 95% CI, 1.06‐5.76) were associated with DMFS. Among patients with BRPC and LAPC who complete surgical resection, neoadjuvant mFOLF was associated with improved pathological and clinical outcomes compared with nab‐P/G.
Highlights
In the United States, there will be an estimated 56 770 new cases of pancreatic carcinoma (PC) and 45 750 estimated deaths in 2019.1 The 5-year overall survival (OS) rate remains dismal at only 9%, and PC is projected to become the second leading cause of cancer-related death by 2030.2 Forty percent of pancreatic ductal adenocarcinoma (PDAC) patients present with metastatic disease and of the remaining 60%, only 15% will achieve resection, the only curative treatment.[3]
These regimens are favored in the neoadjuvant setting based on two metastatic PDAC phase III trials that showed longer OS with the use of either modified FOLFIRINOX (mFOLF) or nanoparticle albumin–bound paclitaxel plus gemcitabine (nab-P/G) compared to gemcitabine alone.[7,8]
Given the slightly higher radiologic response rates with mFOLF vs nab-P/G in the metastatic setting, we hypothesized mFOLF would result in greater radiographic, serum carbohydrate antigen 19-9 (CA 19-9), and pathological response rates compared to nab-P/G in patients with borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC)
Summary
In the United States, there will be an estimated 56 770 new cases of pancreatic carcinoma (PC) and 45 750 estimated deaths in 2019.1 The 5-year overall survival (OS) rate remains dismal at only 9%, and PC is projected to become the second leading cause of cancer-related death by 2030.2 Forty percent of pancreatic ductal adenocarcinoma (PDAC) patients present with metastatic disease and of the remaining 60%, only 15% will achieve resection, the only curative treatment.[3]. Modified FOLFIRINOX (mFOLF) (5-FU, leucovorin, irinotecan, and oxaliplatin) or nanoparticle albumin–bound paclitaxel (nab-paclitaxel) plus gemcitabine (nab-P/G) are the two most common chemotherapy regimens utilized in BRPC or LAPC These regimens are favored in the neoadjuvant setting based on two metastatic PDAC phase III trials that showed longer OS with the use of either mFOLF or nab-P/G compared to gemcitabine alone.[7,8]. Given the slightly higher radiologic response rates with mFOLF vs nab-P/G in the metastatic setting, we hypothesized mFOLF would result in greater radiographic, serum CA 19-9, and pathological response rates compared to nab-P/G in patients with BRPC and LAPC. For borderline resectable or unresectable disease, intensive multidrug chemotherapy regimens with either modified FOLFIRINOX (mFOLF) or nab-paclitaxel plus gemcitabine are preferred We retrospectively compared these two chemotherapy regimens in patients who completed resection and found the mFOLF group had better overall clinical and pathological response rates. We compared the tumor treatment effects based on changes in pre- and post-NAT tumor size on imaging, changes in carbohydrate antigen 19-9 (CA 19-9), and treatment response grading on pathological reports between the two chemotherapy regimens, as well as clinical outcomes
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