Neoadjuvant FOLFIRINOX Application in Borderline Resectable Pancreatic Adenocarcinoma

Abstract

Abstract5-Fluorouracile, oxaliplatin, irinotecan, and leucovorin (FOLFIRINOX) has not been extensively used in the neoadjuvant setting because of concerns with safety and toxicity. We evaluated our institutional experience with neoadjuvant FOLFIRINOX in borderline resectable pancreatic adenocarcinoma (BRPAC). The primary endpoints were completion of therapy to surgery and negative resection margin (R0) rate.Patients with BRPAC treated with neoadjuvant FOLFIRINOX were retrospectively analyzed. Between August 2011 and September 2013, 20 patients with BRPAC treated with neoadjuvant FOLFIRINOX were identified.Most patients (88.8%) completed FOLFIRINOX therapy and underwent resection. Abutment of venous structures was identified in 13 cases (72.2%), while short segment portal vein encasement in 3 cases (16.6%) with concomitant arterial involvement in 3 cases (16.6%). Isolated superior mesenteric artery abutment was identified in 2 cases (11.2%). Patients received a median of 4 cycles of FOLFIRINOX. There was 1 case of progression. Vascular resection was performed in 9 cases (52.9%). Preoperative radiation therapy was used in 8 patients (44%). All patients underwent margin negative resection (R0). Histopathologic treatment response was evident in 10 cases (58.8%).Neoadjuvant FOLFIRINOX was generally safe and the expected toxicity did not prevent surgery allowing for a high rate of R0 resection.

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

“…FOLFIRINOX regimen resulted in a statistically significant increase in OS (11.1 vs. 6.8 months; P<0.001) and RR (31.6 vs. 9.4%; P<0.001) compared with the results observed with gemcitabine in patients with metastatic disease (6). Thus, FOLFIRINOX has been incorporated in neoadjuvant trials for BRPAC and LAPAC (Table I), either alone or in combination with chemoradiation (43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59).…”

Resectability After First-Line FOLFIRINOX in Initially Unresectable Locally Advanced Pancreatic Cancer: A Single-Center Experience

“…Based on the experience in the metastatic setting, many institutions started to recommend the neoadjuvant administration of FOLFIRINOX for patients who were borderline resectable, or locally advanced unresectable. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Since the ACCORD trial was published in 2011, many retrospective studies have confirmed encouraging results for FOLFIRINOX as induction therapy for patients with initially locally advanced PDAC. 9,11 R0 resections are achieved in 40 % of patients with initially borderline/unresectable PDAC.…”

Inverse probability of treatment weighting analysis of upfront surgery versus neoadjuvant chemoradiotherapy followed by surgery for pancreatic adenocarcinoma with arterial abutment

“…Recently, a number of studies have reported the results of treatment using neoadjuvant FOLFIRINOX, an exceedingly promising chemotherapy regimen. 40,41 Ferrone et al reported outstanding short-term outcomes in patients with BR and locally advanced PDAC. The efficacy of neoadjuvant FOLFIR-INOX was found to be potentially superior to that in the current study with a remarkable decrease in pre-and posttreatment median CA19-9 level from 169 to 0.17 U/mL and a resection rate of 100%.…”