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

• Published in: Annals of Surgical Oncology Vol. 23; no. 13; pp. 4352 - 4360
• Main Authors: Rombouts, Steffi J., Walma, Marieke S., Vogel, Jantien A., van Rijssen, Lennart B., Wilmink, Johanna W., Mohammad, Nadia Haj, van Santvoort, Hjalmar C., Molenaar, I. Quintus, Besselink, Marc G.
• Format: Journal Article Book Review
• Language: English
• Published: Cham Springer International Publishing 01.12.2016; Springer Nature B.V
• Subjects: Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; CA-19-9 Antigen - blood; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Carcinoma, Pancreatic Ductal - blood; Carcinoma, Pancreatic Ductal - therapy; Chemotherapy, Adjuvant; Clinical outcomes; Fluorouracil - administration & dosage; Gastrointestinal Oncology; Humans; Leucovorin - administration & dosage; Medicine; Medicine & Public Health; Neoadjuvant Therapy; Oncology; Organoplatinum Compounds - administration & dosage; Pancreatectomy; Pancreatic cancer; Pancreatic Neoplasms - blood; Pancreatic Neoplasms - therapy; Radiotherapy; Radiotherapy, Adjuvant; Surgery; Surgical Oncology; Survival Rate; National Comprehensive Cancer Network; Complete Pathologic Response; Pancreatic Cancer; Resection Rate
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5373-2

Background FOLFIRINOX 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. Methods The PubMed, EMBASE and Cochrane library databases were systematically searched for studies published to 31 August 2015. Primary outcome was the (R0) resection rate. Results Fourteen 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. Conclusions Outcomes after FOLFIRINOX-based therapy in patients with LAPC seem very promising but further prospective studies are needed, especially with regard to survival after resection.