Impact of neoadjuvant FOLFIRINOX over upfront resection in borderline resectable pancreatic cancer—an international, multicentre, real-world analysis

Impact of neoadjuvant FOLFIRINOX over upfront resection in borderline resectable pancreatic cancer—an international, multicentre, real-world analysis

Background: This study explores the potential benefits of neoadjuvant chemotherapy in borderline resectable (BR) pancreatic adenocarcinoma. Despite neoadjuvant treatment (NAT) increasingly being utilised, uncertainty remains as to the optimal approach. Patients and methods: This study assessed clini...

Full description

Saved in:
Bibliographic Details
Main Authors: S. Banks, W. Hong, K. Degeling, J. Shapiro, B. Thomson, H.S. Ko, S. Ananda, A. Jalali, Y.H. To, B. Loveday, S.-A. McLachlan, B. Knowles, A. Fox, M. Michael, R. Wong, M. Burge, K. Clarke, S. Pattison, M. Nikfarjam, R. Zielinski, F. Day, C.E. Chee, A. Nagrial, M. IJzerman, P. Gibbs, B. Lee
Format: Article
Language:English
Published: Elsevier 2024-03-01
Series:ESMO Real World Data and Digital Oncology
Subjects:
pancreatic cancer
neoadjuvant
borderline resectable
data registry
real-world data
Online Access:http://www.sciencedirect.com/science/article/pii/S294982012300022X
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background: This study explores the potential benefits of neoadjuvant chemotherapy in borderline resectable (BR) pancreatic adenocarcinoma. Despite neoadjuvant treatment (NAT) increasingly being utilised, uncertainty remains as to the optimal approach. Patients and methods: This study assessed clinical outcomes for 218 consecutive BR patients from the PURPLE registry. We compared initial surgery (IS) to NAT overall, and between different chemotherapy regimens. Results: Of 1314 non-metastatic patients enrolled, 218 (17%) were considered BR. Of 28 planned for IS, 11/28 (39%) had their tumour excised compared to 68/152 (45%) with NAT (P = 0.59). Among those who received NAT and were resected, 52/100 (52%) received FOLFIRINOX (P = 0.234) and 8/28 (29%) received nab-paclitaxel with gemcitabine (nabPGem). There was no difference in median overall survival (OS) [hazard ratio (HR) 0.72, P = 0.199] between pooled NAT versus IS. Neoadjuvant FOLFIRINOX was associated with improved R0 resection rates (26% versus 7%, P = 0.07) and lower perineural invasion (51% versus 82%, P = 0.02) compared to IS in resected specimens. Neoadjuvant FOLFIRINOX improved OS (HR 0.53, P = 0.02), with a 23% improvement in 2-year OS. There was no difference in survival outcomes between IS and nabPGem. Conclusions: The results of our study suggest that neoadjuvant FOLFIRINOX could improve R0 resection rate and OS compared to IS.
ISSN:2949-8201

Similar Items