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Survival benefit of neoadjuvant FOLFIRINOX for patients with borderline resectable pancreatic cancer
Ann Hepatobiliary Pancreat Surg
Published online February 1, 2024;  https://doi.org/10.14701/ahbps.23-107
Copyright © 2024 The Korean Association of Hepato-Biliary-Pancreatic Surgery.

Evelyn Waugh1, Juan Glinka1, Daniel Breadner2, Rachel Liu1, Ephraim Tang1, Laura Allen1, Stephen Welch2, Ken Leslie1, Anton Skaro1

1Division of General Surgery, Department of Surgery, Western University, London, ON, Canada,
2Division of Medical Oncology, Department of Oncology, Western University, London, ON, Canada
Correspondence to: Juan Glinka, MD
Division of General Surgery, Department of Surgery, Western University, University Hospital, London Health Sciences Centre Room C4-211, 339 Windermere Road London N6A 5A5, ON, Canada
Tel: +1-226-926-0161, Fax: +1-519-633-3858, E-mail: Juan.glinka@lhsc.on.ca
ORCID: https://orcid.org/0000-0003-4373-965X
Received September 14, 2023; Revised December 5, 2023; Accepted December 9, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Backgrounds/Aims: While patients with borderline resectable pancreatic cancer (BRPC) are a target population for neoadjuvant chemotherapy (NAC), formal guidelines for neoadjuvant therapy are lacking. We assessed the perioperative and oncological outcomes in patients with BRPC undergoing NAC with FOLFIRINOX for patients undergoing upfront surgery (US).
Methods: The AHPBA criteria for borderline resectability and/or a CA19-9 level > 100 μ/mL defined borderline resectable tumors retrieved from a prospectively populated institutional registry from 2007 to 2020. The primary outcome was overall survival (OS) at 1 and 3 years. A Cox Proportional Hazard model based on intention to treat was used. A receiver–operator characteristics (ROC) curve was constructed to assess the discriminatory capability of the use of CA19-9 > 100 μ/mL to predict resectability and mortality.
Results: Forty BRPC patients underwent NAC, while 46 underwent US. The median OS with NAC was 19.8 months (interquartile range [IQR] 10.3−44.24) vs. 10.6 months (IQR 6.37−17.6) with US. At 1 year, 70% of the NAC group and 41.3% of the US group survived (p = 0.008). At 3 years, 42.5 % of the NAC group and 10.9% of the US group survived (p = 0.001). NAC significantly reduced the hazard of death (adjusted hazard ratio, 0.20; 95% confidence interval, 0.07−0.54; p = 0.001). CA19-9 > 100 μ/mL showed poor discrimination in predicting mortality, but was a moderate predictor of resectability.
Conclusions: We found a survival benefit of NAC with FOLFIRINOX for BRPC. Greater pre-treatment of CA19-9 and multivessel involvement on initial imaging were associated with progression of the disease following NAC.
Keywords : Pancreatic cancer; Pancreatic neoplasms; Neoadjuvant therapy; CA-19-9 antigen

 

February 2024, 28 (1)