Continued adjuvant FOLFIRINOX for BRPC or LAPC after neoadjuvant FOLFIRINOX

• Published in: Journal of cancer research and clinical oncology Vol. 149; no. 5; pp. 1765 - 1775
• Main Authors: Park, Jaewoo, Kim, Hae Young, Na, Hee Young, Lee, Jun Suh, Lee, Jong-Chan, Kim, Jin Won, Yoon, Yoo-Seok, Hwang, Jin-Hyeok, Han, Ho-Seong, Kim, Jaihwan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2023; Springer Nature B.V
• Subjects: Adjuvants, Immunologic - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer Research; Female; Fluorouracil - therapeutic use; Hematology; Humans; Internal Medicine; Leucovorin - therapeutic use; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Oncology; Original Article – Clinical Oncology; Pancreatic cancer; Pancreatic Neoplasms; Patients; Retrospective Studies; Surgery; Survival; Neoadjuvant chemotherapy; Adjuvant chemotherapy; Survival; Pancreatic cancer; Pancreatectomy
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-022-04108-9

Purpose We aimed to assess the role of adjuvant FOLFIRINOX, in comparison with other adjuvant therapy, in patients who received neoadjuvant FOLFIRINOX and surgery for borderline resectable or locally advanced pancreatic cancer (BRPC or LAPC). Methods Our target population was patients with BRPC or LAPC, who received adjuvant therapy following neoadjuvant FOLFIRINOX and surgery between June 2013 and October 2020. Multivariable Cox proportional-hazard model was used to identify factors associated with overall survival (OS) and recurrence free survival (RFS). Results Among 244 patients with BRPC or LAPC who received neoadjuvant FOLFIRINOX, 79 patients underwent subsequent surgery. Among them, 58 who received adjuvant therapy [median age, 63 years; 33 females (56.9%)] were included. Thirty patients received adjuvant modified FOLFIRINOX (mFOLFIRINOX), while 28 received adjuvant therapy other than FOLFIRINOX. In multivariable analysis, mFOLFIRINOX and post-treatment carbohydrate antigen 19-9 (CA 19-9) were significantly associated with OS and RFS. According to mFOLFIRINOX vs. other adjuvant therapy, median OS was not reached at 37.5 months of follow-up vs. 29.7 months ( P  = .012); and median RFS was 30.5 vs. 11.0 months ( P  = .028). According to post-treatment CA 19-9 (< 37 vs. ≥ 37 U/mL), median OS was 46.0 vs. 25.5 months ( P  = .022); and median RFS was 25.9 vs. 7.6 months ( P  = .012). Conclusion Continued adjuvant mFOLFIRINOX and post-treatment CA 19-9 level were associated with survival in patients with BRPC or LAPC who received neoadjuvant FOLFIRINOX and surgery. Continued adjuvant mFOLFIRINOX after neoadjuvant FOLFIRINOX could be considered for patients with good performance.