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Open Access Highly Accessed Research article

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

Peter J Hosein1*, Jessica Macintyre2, Carolina Kawamura3, Jennifer Cudris Maldonado4, Vinicius Ernani5, Arturo Loaiza-Bonilla6, Govindarajan Narayanan7, Afonso Ribeiro8, Lorraine Portelance9, Jaime R Merchan10, Joe U Levi11 and Caio M Rocha-Lima12

Author Affiliations

1 Department of Medicine, Division of Hematology/Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

2 Institution: Department of Medicine, Division of Hematology/Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

3 Advanced Oncology Center of Hospital São José, São Paulo, Brasil

4 Department of Medicine, Division of Hematology/Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

5 Department of Medicine, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

6 Department of Medicine, Division of Hematology/Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

7 Department of Radiology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

8 Department of Medicine, Division of Gastroenterology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

9 Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

10 Department of Medicine, Division of Hematology/Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

11 Department of Surgery, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

12 Department of Medicine, Division of Hematology/Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

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BMC Cancer 2012, 12:199  doi:10.1186/1471-2407-12-199

Published: 29 May 2012

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.

Keywords:
Pancreatic ductal carcinoma; neoadjuvant therapy; surgery; radiation therapy