FOLFIRINOX-Based Neoadjuvant Therapy in Borderline Resectable or Unresectable Pancreatic Cancer

Petrelli, Fausto; Coinu, Andrea; Borgonovo, Karen; Cabiddu, Mary; Ghilardi, Mara; Lonati, Veronica; Aitini, Enrico; Barni, Sandro

doi:10.1097/mpa.0000000000000314

Cited by 171 publications

(122 citation statements)

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“…Several systematic reviews with meta‐analysis have been performed to analyse the effect of neoadjuvant therapy in patients with PDAC on survival26, 27, 28, R0 resection rates26 and resectability rates28. Although the clinical benefit of neoadjuvant therapy on overall and progression‐ and disease‐free survival is still debated, its effect on relevant histopathological features of PDAC is well understood22 29.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

et al. 2018

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BackgroundNeoadjuvant therapy may increase the rate of radical tumour resection in patients with pancreatic cancer. Its impact on tumour recurrence has not been investigated fully. This study aimed to assess the impact of neoadjuvant therapy on patterns of recurrence.MethodsA systematic review was performed of articles identified through the PubMed, Scopus, Embase, Ovid and Google Scholar databases that analysed the relationship between neoadjuvant therapy and recurrence published to January 2016. The main endpoint was overall tumour recurrence. Other endpoints included local recurrence, any kind of distant, hepatic, pulmonary or peritoneal metastasis.ResultsA total of 4257 citations were reviewed. Twelve observational studies comprising 1365 patients were analysed. Neoadjuvant therapy significantly reduced the risk of overall (risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·90; P < 0·001) and local (RR 0·42, 0·32 to 0·55; P < 0·001) recurrence. Neoadjuvant therapy did not reduce the risk of any kind of distant (RR 1·02, 0·91 to 1·14; P = 0·78), hepatic (RR 0·86, 0·68 to 1·10; P = 0·23), pulmonary (RR 0·99, 0·37 to 2·66; P = 0·98) or peritoneal (RR 0·88, 0·57 to 1·38; P = 0·58) metastasis.ConclusionNeoadjuvant therapy reduced the risk of local recurrence but not that of distant metastasis.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

et al. 2018

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“…Viele weitere retrospektive Studien haben diese vielversprechenden Ergebnisse für FOLFIRINOX als alleinige neoadjuvante Therapie oder als Teil einer multimodalen Therapie für Patienten mit initial grenzwertig resektablen oder lokal fortgeschrittenen, nichtresektablen Pankreaskarzinomen bestätigt [26]. Eine kürz-lich publizierte Metaanalyse dieser Studien zeigte eine Resektionsrate von 69 % (R0-Rate von 93 %) bei initial grenzwertig resektablen Tumoren und von 26 % (R0-Rate von 86 %) bei initial lokal fortgeschrittenen, nichtresektablen Tumoren [26].…”

Section: » Die Ergebnisse Für Folfirinox Sind Vielversprechendunclassified

“…Eine kürz-lich publizierte Metaanalyse dieser Studien zeigte eine Resektionsrate von 69 % (R0-Rate von 93 %) bei initial grenzwertig resektablen Tumoren und von 26 % (R0-Rate von 86 %) bei initial lokal fortgeschrittenen, nichtresektablen Tumoren [26].…”

Section: » Die Ergebnisse Für Folfirinox Sind Vielversprechendunclassified

Resektion beim fortgeschrittenen Pankreaskarzinom nach multimodaler Vorbehandlung

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et al. 2016

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“…Since FOLFIRINOX is superior to gemcitabine in good performance status patients [4] with metastatic pancreatic cancer, several retrospective studies have evaluated the use of this regimen in the neoadjuvant setting reporting resection rates ranging from 33 to 42% and R0 resection rates from 55 to 92% [21,53,91,[94][95][96]. Since there is significant toxicity associated with this regimen, investigators are exploring a modified FOLFIRINOX dose schedule as neoadjuvant therapy [95].…”

Section: • Neoadjuvant Chemotherapy (Without Radiation)mentioning

confidence: 99%

“…The R0 resection rate was 87% and a median OS of 16 months was observed for those who underwent resection compared with 12 months for those who did not [75]. Despite a lack of radiation and inclusion of patients with locally advanced unresectable disease in these trials, the overall resection and R0 resection rates were high, indicating that chemotherapy alone has a role in the n eoadjuvant setting.Since FOLFIRINOX is superior to gemcitabine in good performance status patients [4] with metastatic pancreatic cancer, several retrospective studies have evaluated the use of this regimen in the neoadjuvant setting reporting resection rates ranging from 33 to 42% and R0 resection rates from 55 to 92% [21,53,91,[94][95][96]. Since there is significant toxicity associated with this regimen, investigators are exploring a modified FOLFIRINOX dose schedule as neoadjuvant therapy [95].…”

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The Role of Neoadjuvant Therapy in Pancreatic Cancer: A Review

et al. 2016

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Controversy remains regarding neoadjuvant approaches in the treatment of pancreatic cancer. Neoadjuvant therapy has several potential advantages over adjuvant therapy including earlier delivery of systemic treatment, in vivo assessment of response, increased resectability rate in borderline resectable patients and increased margin-negative resection rate. At present, there are no randomized data favoring neoadjuvant over adjuvant therapy and multiple neoadjuvant approaches are under investigation. Combination chemotherapy regimens including 5-fluorouracil, irinotecan and oxaliplatin, gemcitabine with or without abraxane, or docetaxel and capecitabine have been used in the neoadjuvant setting. Radiation and chemoradiation have also been incorporated into neoadjuvant strategies, and delivery of alternative fractionation regimens is being explored. This review provides an overview of neoadjuvant therapies for pancreatic cancer. KEYWORDS• 5-fluorouracilPancreatic adenocarcinoma is considered one of the most aggressive malignancies. Most patients are diagnosed with advanced stage disease and only 15-20% of patients are considered candidates for curative resection. An additional 5-10% is diagnosed with borderline resectable or locally advanced disease. Although surgical resection is considered the only potentially curative treatment, resection alone results in low cure rates with median overall survival (OS) rates of approximately 20 months [1,2]. Pancreatic cancer is biologically aggressive and lacks therapeutic agents that are effective against micrometastases. Even in patients who undergo complete surgical resection followed by adjuvant chemotherapy with or without radiation, the risk for systemic recurrence can be as high as 77%, and may be either locoregional or distant in nature [3].Response rates to adjuvant therapies are variable and there is no reliable method to identify which patients will respond to treatment. Nonetheless, some randomized studies demonstrate OS and disease-free survival advantages associated with adjuvant therapies for resectable pancreatic cancer [4,5].Unlike adjuvant therapy, a neoadjuvant treatment approach potentially allows for in vivo assessment of tumor response. In addition, the use of early systemic therapy prior to surgery allows treatment of radiographically undetectable metastatic disease in some patients. It has been reported that 670REviEW Russo, Ammori, Eads & Dorth future science group disease progression occurs in 45-74% following neoadjuvant chemoradiation [6][7][8][9] and 30-78% following neoadjuvant chemotherapy [10] . Noncurative surgery and its associated risks can be avoided in patients who demonstrate disease progression following n eoadjuvant therapy.Neoadjuvant treatment also has the potential to improve compliance [11] as adjuvant therapy is frequently delayed due to recovery from surgery. It is estimated that approximately 25% of patients undergoing curative resection for pancreatic cancer do not receive the planned postoperative treatment due to surgical co...

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FOLFIRINOX-Based Neoadjuvant Therapy in Borderline Resectable or Unresectable Pancreatic Cancer

Abstract: This meta-analysis shows that down-staging after neoadjuvant FOLFIRINOX-based therapy is noticeable in patients with borderline resectable/unresectable PC, with a total R0 resection rate of 40%.

Cited by 171 publications

References 29 publications

Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma

Resektion beim fortgeschrittenen Pankreaskarzinom nach multimodaler Vorbehandlung

The Role of Neoadjuvant Therapy in Pancreatic Cancer: A Review

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