A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma

Peter J. Hosein, Jessica Macintyre, Carolina Kawamura, Jennifer C. Maldonado, Vinicius Ernani, Arturo Loaiza-Bonilla, Govindarajan Narayanan, Afonso Ribeiro, Lorraine Portelance, Jaime R. Merchan, Joe U. Levi, Caio M. Rocha-Lima

Research output: Contribution to journalArticle

148 Citations (Scopus)

Abstract

Background: 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (FOLFIRINOX) is superior to gemcitabine in patients with metastatic pancreatic cancer who have a good performance status. We investigated this combination as neoadjuvant therapy for locally advanced pancreatic cancer (LAPC).Methods: In this retrospective series, we included patients with unresectable LAPC who received neoadjuvant FOLFIRINOX with growth factor support. The primary analysis endpoint was R0 resection rate.Results: Eighteen treatment-naïve patients with unresectable or borderline resectable LAPC were treated with neoadjuvant FOLFIRINOX. The median age was 57.5 years and all had ECOG PS of 0 or 1. Eleven (61 %) had tumors in the head of the pancreas and 9 (50 %) had biliary stents placed prior to chemotherapy. A total of 146 cycles were administered with a median of 8 cycles (range 3-17) per patient. At maximum response or tolerability, 7 (39 %) were converted to resectability by radiological criteria; 5 had R0 resections, 1 had an R1 resection, and 1 had unresectable disease. Among the 11 patients who remained unresectable after FOLFIRINOX, 3 went on to have R0 resections after combined chemoradiotherapy, giving an overall R0 resection rate of 44 % (95 % CI 22-69 %). After a median follow-up of 13.4 months, the 1-year progression-free survival was 83 % (95 % CI 59-96 %) and the 1-year overall survival was 100 % (95 % CI 85-100 %). Grade 3/4 chemotherapy-related toxicities were neutropenia (22 %), neutropenic fever (17 %), thrombocytopenia (11 %), fatigue (11 %), and diarrhea (11 %). Common grade 1/2 toxicities were neutropenia (33 %), anemia (72 %), thrombocytopenia (44 %), fatigue (78 %), nausea (50 %), diarrhea (33 %) and neuropathy (33 %).Conclusions: FOLFIRINOX followed by chemoradiotherapy is feasible as neoadjuvant therapy in patients with unresectable LAPC. The R0 resection rate of 44 % in this population is promising. Further studies are warranted.

Original languageEnglish (US)
Article number199
JournalBMC cancer
Volume12
DOIs
StatePublished - May 29 2012

Fingerprint

Pancreatic Neoplasms
Adenocarcinoma
Retrospective Studies
irinotecan
oxaliplatin
Neoadjuvant Therapy
Chemoradiotherapy
gemcitabine
Neutropenia
Thrombocytopenia
Fatigue
Diarrhea
Drug Therapy
Leucovorin
Fluorouracil
Nausea
Disease-Free Survival
Stents
Anemia
Pancreas

Keywords

  • Neoadjuvant therapy
  • Pancreatic ductal carcinoma
  • Radiation therapy
  • Surgery

ASJC Scopus subject areas

  • Genetics
  • Oncology
  • Cancer Research

Cite this

A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma. / Hosein, Peter J.; Macintyre, Jessica; Kawamura, Carolina; Maldonado, Jennifer C.; Ernani, Vinicius; Loaiza-Bonilla, Arturo; Narayanan, Govindarajan; Ribeiro, Afonso; Portelance, Lorraine; Merchan, Jaime R.; Levi, Joe U.; Rocha-Lima, Caio M.

In: BMC cancer, Vol. 12, 199, 29.05.2012.

Research output: Contribution to journalArticle

Hosein, PJ, Macintyre, J, Kawamura, C, Maldonado, JC, Ernani, V, Loaiza-Bonilla, A, Narayanan, G, Ribeiro, A, Portelance, L, Merchan, JR, Levi, JU & Rocha-Lima, CM 2012, 'A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma', BMC cancer, vol. 12, 199. https://doi.org/10.1186/1471-2407-12-199
Hosein, Peter J. ; Macintyre, Jessica ; Kawamura, Carolina ; Maldonado, Jennifer C. ; Ernani, Vinicius ; Loaiza-Bonilla, Arturo ; Narayanan, Govindarajan ; Ribeiro, Afonso ; Portelance, Lorraine ; Merchan, Jaime R. ; Levi, Joe U. ; Rocha-Lima, Caio M. / A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma. In: BMC cancer. 2012 ; Vol. 12.
@article{1460be6473304038a156bad01253dd3c,
title = "A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma",
abstract = "Background: 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (FOLFIRINOX) is superior to gemcitabine in patients with metastatic pancreatic cancer who have a good performance status. We investigated this combination as neoadjuvant therapy for locally advanced pancreatic cancer (LAPC).Methods: In this retrospective series, we included patients with unresectable LAPC who received neoadjuvant FOLFIRINOX with growth factor support. The primary analysis endpoint was R0 resection rate.Results: Eighteen treatment-na{\"i}ve patients with unresectable or borderline resectable LAPC were treated with neoadjuvant FOLFIRINOX. The median age was 57.5 years and all had ECOG PS of 0 or 1. Eleven (61 {\%}) had tumors in the head of the pancreas and 9 (50 {\%}) had biliary stents placed prior to chemotherapy. A total of 146 cycles were administered with a median of 8 cycles (range 3-17) per patient. At maximum response or tolerability, 7 (39 {\%}) were converted to resectability by radiological criteria; 5 had R0 resections, 1 had an R1 resection, and 1 had unresectable disease. Among the 11 patients who remained unresectable after FOLFIRINOX, 3 went on to have R0 resections after combined chemoradiotherapy, giving an overall R0 resection rate of 44 {\%} (95 {\%} CI 22-69 {\%}). After a median follow-up of 13.4 months, the 1-year progression-free survival was 83 {\%} (95 {\%} CI 59-96 {\%}) and the 1-year overall survival was 100 {\%} (95 {\%} CI 85-100 {\%}). Grade 3/4 chemotherapy-related toxicities were neutropenia (22 {\%}), neutropenic fever (17 {\%}), thrombocytopenia (11 {\%}), fatigue (11 {\%}), and diarrhea (11 {\%}). Common grade 1/2 toxicities were neutropenia (33 {\%}), anemia (72 {\%}), thrombocytopenia (44 {\%}), fatigue (78 {\%}), nausea (50 {\%}), diarrhea (33 {\%}) and neuropathy (33 {\%}).Conclusions: FOLFIRINOX followed by chemoradiotherapy is feasible as neoadjuvant therapy in patients with unresectable LAPC. The R0 resection rate of 44 {\%} in this population is promising. Further studies are warranted.",
keywords = "Neoadjuvant therapy, Pancreatic ductal carcinoma, Radiation therapy, Surgery",
author = "Hosein, {Peter J.} and Jessica Macintyre and Carolina Kawamura and Maldonado, {Jennifer C.} and Vinicius Ernani and Arturo Loaiza-Bonilla and Govindarajan Narayanan and Afonso Ribeiro and Lorraine Portelance and Merchan, {Jaime R.} and Levi, {Joe U.} and Rocha-Lima, {Caio M.}",
year = "2012",
month = "5",
day = "29",
doi = "10.1186/1471-2407-12-199",
language = "English (US)",
volume = "12",
journal = "BMC Cancer",
issn = "1471-2407",
publisher = "BioMed Central",

}

TY - JOUR

T1 - A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma

AU - Hosein, Peter J.

AU - Macintyre, Jessica

AU - Kawamura, Carolina

AU - Maldonado, Jennifer C.

AU - Ernani, Vinicius

AU - Loaiza-Bonilla, Arturo

AU - Narayanan, Govindarajan

AU - Ribeiro, Afonso

AU - Portelance, Lorraine

AU - Merchan, Jaime R.

AU - Levi, Joe U.

AU - Rocha-Lima, Caio M.

PY - 2012/5/29

Y1 - 2012/5/29

N2 - Background: 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (FOLFIRINOX) is superior to gemcitabine in patients with metastatic pancreatic cancer who have a good performance status. We investigated this combination as neoadjuvant therapy for locally advanced pancreatic cancer (LAPC).Methods: In this retrospective series, we included patients with unresectable LAPC who received neoadjuvant FOLFIRINOX with growth factor support. The primary analysis endpoint was R0 resection rate.Results: Eighteen treatment-naïve patients with unresectable or borderline resectable LAPC were treated with neoadjuvant FOLFIRINOX. The median age was 57.5 years and all had ECOG PS of 0 or 1. Eleven (61 %) had tumors in the head of the pancreas and 9 (50 %) had biliary stents placed prior to chemotherapy. A total of 146 cycles were administered with a median of 8 cycles (range 3-17) per patient. At maximum response or tolerability, 7 (39 %) were converted to resectability by radiological criteria; 5 had R0 resections, 1 had an R1 resection, and 1 had unresectable disease. Among the 11 patients who remained unresectable after FOLFIRINOX, 3 went on to have R0 resections after combined chemoradiotherapy, giving an overall R0 resection rate of 44 % (95 % CI 22-69 %). After a median follow-up of 13.4 months, the 1-year progression-free survival was 83 % (95 % CI 59-96 %) and the 1-year overall survival was 100 % (95 % CI 85-100 %). Grade 3/4 chemotherapy-related toxicities were neutropenia (22 %), neutropenic fever (17 %), thrombocytopenia (11 %), fatigue (11 %), and diarrhea (11 %). Common grade 1/2 toxicities were neutropenia (33 %), anemia (72 %), thrombocytopenia (44 %), fatigue (78 %), nausea (50 %), diarrhea (33 %) and neuropathy (33 %).Conclusions: FOLFIRINOX followed by chemoradiotherapy is feasible as neoadjuvant therapy in patients with unresectable LAPC. The R0 resection rate of 44 % in this population is promising. Further studies are warranted.

AB - Background: 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (FOLFIRINOX) is superior to gemcitabine in patients with metastatic pancreatic cancer who have a good performance status. We investigated this combination as neoadjuvant therapy for locally advanced pancreatic cancer (LAPC).Methods: In this retrospective series, we included patients with unresectable LAPC who received neoadjuvant FOLFIRINOX with growth factor support. The primary analysis endpoint was R0 resection rate.Results: Eighteen treatment-naïve patients with unresectable or borderline resectable LAPC were treated with neoadjuvant FOLFIRINOX. The median age was 57.5 years and all had ECOG PS of 0 or 1. Eleven (61 %) had tumors in the head of the pancreas and 9 (50 %) had biliary stents placed prior to chemotherapy. A total of 146 cycles were administered with a median of 8 cycles (range 3-17) per patient. At maximum response or tolerability, 7 (39 %) were converted to resectability by radiological criteria; 5 had R0 resections, 1 had an R1 resection, and 1 had unresectable disease. Among the 11 patients who remained unresectable after FOLFIRINOX, 3 went on to have R0 resections after combined chemoradiotherapy, giving an overall R0 resection rate of 44 % (95 % CI 22-69 %). After a median follow-up of 13.4 months, the 1-year progression-free survival was 83 % (95 % CI 59-96 %) and the 1-year overall survival was 100 % (95 % CI 85-100 %). Grade 3/4 chemotherapy-related toxicities were neutropenia (22 %), neutropenic fever (17 %), thrombocytopenia (11 %), fatigue (11 %), and diarrhea (11 %). Common grade 1/2 toxicities were neutropenia (33 %), anemia (72 %), thrombocytopenia (44 %), fatigue (78 %), nausea (50 %), diarrhea (33 %) and neuropathy (33 %).Conclusions: FOLFIRINOX followed by chemoradiotherapy is feasible as neoadjuvant therapy in patients with unresectable LAPC. The R0 resection rate of 44 % in this population is promising. Further studies are warranted.

KW - Neoadjuvant therapy

KW - Pancreatic ductal carcinoma

KW - Radiation therapy

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84861465672&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861465672&partnerID=8YFLogxK

U2 - 10.1186/1471-2407-12-199

DO - 10.1186/1471-2407-12-199

M3 - Article

C2 - 22642850

AN - SCOPUS:84861465672

VL - 12

JO - BMC Cancer

JF - BMC Cancer

SN - 1471-2407

M1 - 199

ER -