Comparison of Clinical Outcomes of Borderline Resectable Pancreatic Cancer According to the Neoadjuvant Chemo-Regimens: Gemcitabine versus FOLFIRINOX

Abstract

Background/Aims: Although many studies have reported the promising effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC) to increase resectability, only a few studies have recommended the use of firstline chemotherapeutic agents as neoadjuvant treatment for BRPC. The current study compared clinical outcomes between gemcitabine and FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) in patients with BRPC. Methods: In this single-center retrospective study, 100 BRPC patients treated with neoadjuvant chemotherapy and resection from 2008 to 2018 were reviewed. Clinical outcomes included overall survival, resectability, and recurrence patterns after gemcitabine or FOLFIRINOX treatment. Results: For neoadjuvant chemotherapy, gemcitabine was administered to 34 patients and FOLFIRINOX to 66. Neoadjuvant radiotherapy was administered to 27 patients (79.4%) treated with gemcitabine and 19 (28.8%) treated with FOL-FIRINOX (p<0.001). The 2-and 5-year survival rates (YSRs) were significantly higher after FOLFIRINOX (2YSR, 72.2%; 5YSR, 46.0%) than after gemcitabine (2YSR, 58.4%; 5YSR, 19.1%; p=0.041). The margin negative rate was comparable (gemcitabine, 94.1%; FOLFIRINOX, 92.4%; p=0.753), and the tumor size change in percentage showed only a marginal difference (gemcitabine, 20.5%; FOLFIRINOX, 29.0%; p=0.069). Notably, the metastatic recurrence rate was significantly lower in the FOLFIRINOX group (n=20, 52.6%) than in the gemcitabine group (n=22, 78.6%; p=0.001). The rate of adverse events after chemotherapy was significantly higher with FOLFIRINOX than with gemcitabine (43.9%, 20.6%, respectively; p=0.037). Conclusions: FOLFIRINOX provided more clinical and oncological benefit than gemcitabine, with significantly higher overall survival and lower cumulative recurrence rates in BRPC. However, since FOLFIRINOX causes more adverse effects, the regimen should be individualized based on patient's general condition and clinical status.

Staging CT and Diagnostic Laparoscopy With Cytology Prior to the Treatment of Pancreatic Adenocarcinoma: A Case Series

“…Evidence from the literature suggests that adequate chemotherapy, independent of resection status, can increase progression-free survival, which strongly correlates with increased overall survival [ 27 ]. There also appears to be a greater survival benefit with higher potency regimens than lower potency regimens, even in patients with locally advanced and metastatic tumors [ 20 , 28 , 29 ]. Since the use of high-potency chemotherapy is dependent on optimal performance status, considering a patient’s functional capacity could help guide the use of invasive staging.…”

Borderline resectable pancreatic cancer: Certainties and controversies

“…Paniccia et al [ 34 ] reported the outcomes of BR patients treated with neoadjuvant FOLFIRINOX: 94% underwent R0 resection and, with a median follow-up of 14.5 mo, median OS was not yet reached. Several other studies demonstrating the efficacy of FOLFIRINOX as neoadjuvant treatment for BR-PDAC have been published[ 35 , 36 ].…”

Comparing concurrent chemoradiotherapy, 125I seed implantation combined with chemotherapy, and chemotherapy alone efficacy in treating unresectable locally advanced pancreatic cancer

“…The primary treatment method for resectable locally advanced pancreatic cancer (LAPC) remains surgery followed by adjuvant chemotherapy with/without adjuvant radiation 6 . Multiagent chemotherapy, such as FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, fluorouracil) or gemcitabine/abraxane, followed by fluoropyrimidine‐based concurrent chemoradiotherapy (CCRT) and surgery or gemcitabine‐based CCRT and medical surgery, is the treatment paradigm for borderline resectable LAPC 7 . CCRT, 125 I seed implantation combined with chemotherapy (125IC), and chemotherapy alone (CA) are all common treatment options for unresectable LAPC, but the best treatment option is still up for debate.…”

“…6 Multiagent chemotherapy, such as FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, fluorouracil) or gemcitabine/abraxane, followed by fluoropyrimidine-based concurrent chemoradiotherapy (CCRT) and surgery or gemcitabine-based CCRT and medical surgery, is the treatment paradigm for borderline resectable LAPC. 7 CCRT, 125 I seed implantation combined with chemotherapy (125IC), and chemotherapy alone (CA) are all common treatment options for unresectable LAPC, but the best treatment option is still up for debate. Some trials, such as the ECOG 4201 trial, have shown that CCRT improves overall survival (OS) over CA.…”