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FOLFIRINOX as Initial Treatment for Localized Pancreatic Adenocarcinoma: A Retrospective Analysis by the Trans-Atlantic Pancreatic Surgery Consortium.
- Source :
-
Journal of the National Cancer Institute [J Natl Cancer Inst] 2022 May 09; Vol. 114 (5), pp. 695-703. - Publication Year :
- 2022
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Abstract
- Background: Large pragmatic studies of patients who received 5-fluorouracil with leucovorin, irinotecan, and oxaliplatin ([m]FOLFIRINOX) as initial treatment for localized pancreatic ductal adenocarcinoma (PDAC) are lacking. This study aimed to provide realistic estimates of oncologic outcomes in these patients.<br />Methods: This international retrospective cohort study included all consecutive patients presenting with localized PDAC who received at least 1 cycle of (m)FOLFIRINOX as initial treatment in 5 referral centers from the United States and the Netherlands (2012-2019). Primary outcome was median overall survival (OS), calculated from the date of tissue diagnosis, assessed using Kaplan-Meier estimates. Log-rank test was used to compare OS between groups. A Cox proportional hazards regression model was used to assess prognostic baseline factors for OS. All statistical tests were 2-sided.<br />Results: Overall, 1835 patients were included, of whom 958 (52.2%) had locally advanced (LA), 531 (28.9%) had borderline resectable (BR), and 346 (18.9%) had potentially resectable (PR) PDAC. The median number of (m)FOLFIRINOX cycles was 6 (interquartile range = 4-8). Subsequent treatment included second chemotherapy (12.9%), radiotherapy (49.0%), and resection (37.9%). The resection rate was 17.6% for LA, 53.1% for BR, and 70.5% for PR PDAC (P < .001). The margin-negative resection rate (>1 mm) was 55.2% for LA, 62.6% for BR, and 79.2% for PR PDAC (P < .001). The median OS was 18.7 months (95% confidence interval [CI] = 17.7 to 19.9 months) for LA, 23.2 months (95% CI = 21.0 to 25.7 months) for BR, and 31.2 months (95% CI = 26.2 to 36.6 months) for PR PDAC (P < .001). The median OS for 695 patients who underwent a resection was 38.3 months (95% CI = 36.1 to 42.0 months). Independent prognostic factors at baseline for worse OS were more advanced stage, worse performance status, baseline carbohydrate antigen (CA) 19-9 > 500 U/mL, and body mass index ≤18.5 kg/m2.<br />Conclusions: This large international cohort study provides realistic estimates of resection rates and survival in patients with LA, BR, and PR PDAC who started (m)FOLFIRINOX treatment in PDAC referral centers.<br /> (© The Author(s) 2022. Published by Oxford University Press.)
- Subjects :
- Antineoplastic Combined Chemotherapy Protocols therapeutic use
Cohort Studies
Fluorouracil therapeutic use
Humans
Irinotecan therapeutic use
Leucovorin therapeutic use
Neoadjuvant Therapy
Oxaliplatin therapeutic use
Retrospective Studies
Pancreatic Neoplasms
Adenocarcinoma drug therapy
Adenocarcinoma surgery
Carcinoma, Pancreatic Ductal drug therapy
Carcinoma, Pancreatic Ductal surgery
Pancreatic Neoplasms drug therapy
Pancreatic Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2105
- Volume :
- 114
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of the National Cancer Institute
- Publication Type :
- Academic Journal
- Accession number :
- 35157075
- Full Text :
- https://doi.org/10.1093/jnci/djac018