Systematic Review of Resection Rates and Clinical Outcomes After FOLFIRINOX-Based Treatment in Patients with Locally Advanced Pancreatic Cancer

Abstract

BackgroundFOLFIRINOX prolongs survival in patients with metastatic pancreatic cancer and may also benefit patients with locally advanced pancreatic cancer (LAPC). Furthermore, it may downstage a proportion of LAPC into (borderline) resectable disease, however data are lacking. This review assessed outcomes after FOLFIRINOX-based therapy in LAPC.MethodsThe PubMed, EMBASE and Cochrane library databases were systematically searched for studies published to 31 August 2015. Primary outcome was the (R0) resection rate.ResultsFourteen studies involving 365 patients with LAPC were included; three studies administered a modified FOLFIRINOX regimen. Of all patients, 57 % (n = 208) received radiotherapy. The pooled resection rate was 28 % (n = 103, 77 % R0), with a perioperative mortality of 3 % (n = 2), and median overall survival ranged from 8.9 to 25.0 months. Survival data after resection were scarce, with only one study reporting a median overall survival of 24.9 months in 28 patients. A complete pathologic response was found in 6 of 85 (7 %) resected specimens. Dose reductions were described in up to 65 % of patients, grade 3–4 toxicity occurred in 23 % (n = 51) of patients, and 2 % (n = 5) had to discontinue treatment. Data of patients treated solely with FOLFIRINOX, without additional radiotherapy, were available from 292 patients: resection rate was 12 % (n = 29, 70 % R0), with 15.7 months median overall survival and 19 % (n = 34) grade 3–4 toxicity.ConclusionsOutcomes after FOLFIRINOX-based therapy in patients with LAPC seem very promising but further prospective studies are needed, especially with regard to survival after resection.

FOLFIRINOX in Locally Advanced and Metastatic Pancreatic Cancer: A Single Centre Cohort Study

“…The vast majority of patients (90%) were treated with a modified FOLFIRINOX regimen and a median number of 8 cycles (IQR 5-9). Nonetheless, the median OS rate of 14.8 months and 9.0 months, for LAPC and MPC respectively, were similar to the OS rates reported by studies with a lower percentage of dose modifications (14%) and a higher median number of cycles (10 cycles) 5 , 10 . Moreover, the response rate of 26% seen in our patient population is comparable to previous reports of this regimen 5 .…”

“…Our study, however, demonstrated that the majority of grade 3-4 complications related to FOLFIRINOX resolved by dose reduction (Figure 1 ). Our cohort furthermore suggests that, regardless of the dose reductions, patients can still benefit from FOLFIRINOX with survival rates comparable to the study of Conroy et al 5 , 10 .…”

Treatment strategies and clinical outcomes of locally advanced pancreatic cancer patients treated at high-volume facilities and academic centers

“…The resection rates for upfront resectable and LAPC have increased over the past 3 decades, with associated improvement in survival. 4 , 5 , 6 Such improvements have been attributed, in part, to surgery at high-volume facilities (HVFs), likely as a result of higher margin negative resection rates, comprehensive lymph node dissections, lower perioperative mortality, and increased use of adjuvant therapy compared with low volume facilities (LVFs). 7 , 8 , 9 Hospital volume, more than individual surgeon experience, has been associated with improved clinical outcomes, which may be explained by the availability of multidisciplinary management teams at such facilities.…”

The borderline resectable/locally advanced pancreatic ductal adenocarcinoma: What should be the surgeon's choice?

“…A systematic review on clinical outcomes after FOLFIRINOX-based treatment for LA-PDAC demonstrated a 28% resection rate, of which 77% were R0, and a median overall survival ranging between 8.9 and 25.0 months. [ 14 ] These data suggest that FOLFIRINOX-based treatment is indeed a promising option for patients with LA-PDAC, with acceptable toxicity (23% Grade 3–4 complications). Future unselected prospective cohort studies are needed to determine the exact role for FOLFIRINOX in LA-PDAC.…”