Comparison of Clinical Outcomes of Borderline Resectable Pancreatic Cancer According to the Neoadjuvant Chemo-Regimens: Gemcitabine versus FOLFIRINOX
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Background/Aims: Although many studies have reported the promising effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC) to increase resectability, only a few studies have recommended the use of first-line chemotherapeutic agents as neoadjuvant treatment for BRPC. The current study compared clinical outcomes between gemcitabine and FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) in patients with BRPC. Methods: In this single-center retrospective study, 100 BRPC patients treated with neoadjuvant chemotherapy and resection from 2008 to 2018 were reviewed. Clinical outcomes included overall survival, resectability, and recurrence patterns after gemcitabine or FOLFIRINOX treatment. Results: For neoadjuvant chemotherapy, gemcitabine was administered to 34 patients and FOLFIRINOX to 66. Neoadjuvant radiotherapy was administered to 27 patients (79.4%) treated with gemcitabine and 19 (28.8%) treated with FOLFIRINOX (p<0.001). The 2- and 5-year survival rates (YSRs) were significantly higher after FOLFIRINOX (2YSR, 72.2%; 5YSR, 46.0%) than after gemcitabine (2YSR, 58.4%; 5YSR, 19.1%; p=0.041). The margin negative rate was comparable (gemcitabine, 94.1%; FOLFIRINOX, 92.4%; p=0.753), and the tumor size change in percentage showed only a marginal difference (gemcitabine, 20.5%; FOLFIRINOX, 29.0%; p=0.069). Notably, the metastatic recurrence rate was significantly lower in the FOLFIRINOX group (n=20, 52.6%) than in the gemcitabine group (n=22, 78.6%; p=0.001). The rate of adverse events after chemotherapy was significantly higher with FOLFIRINOX than with gemcitabine (43.9%, 20.6%, respectively; p=0.037). Conclusions: FOLFIRINOX provided more clinical and oncological benefit than gemcitabine, with significantly higher overall survival and lower cumulative recurrence rates in BRPC. However, since FOLFIRINOX causes more adverse effects, the regimen should be individualized based on patient’s general condition and clinical status.
Abstract
Background/Aims: Although many studies have reported the promising effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC) to increase resectability, only a few studies have recommended the use of first-line chemotherapeutic agents as neoadjuvant treatment for BRPC. The current study compared clinical outcomes between gemcitabine and FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) in patients with BRPC. Methods: In this single-center retrospective study, 100 BRPC patients treated with neoadjuvant chemotherapy and resection from 2008 to 2018 were reviewed. Clinical outcomes included overall survival, resectability, and recurrence patterns after gemcitabine or FOLFIRINOX treatment. Results: For neoadjuvant chemotherapy, gemcitabine was administered to 34 patients and FOLFIRINOX to 66. Neoadjuvant radiotherapy was administered to 27 patients (79.4%) treated with gemcitabine and 19 (28.8%) treated with FOLFIRINOX (p<0.001). The 2- and 5-year survival rates (YSRs) were significantly higher after FOLFIRINOX (2YSR, 72.2%; 5YSR, 46.0%) than after gemcitabine (2YSR, 58.4%; 5YSR, 19.1%; p=0.041). The margin negative rate was comparable (gemcitabine, 94.1%; FOLFIRINOX, 92.4%; p=0.753), and the tumor size change in percentage showed only a marginal difference (gemcitabine, 20.5%; FOLFIRINOX, 29.0%; p=0.069). Notably, the metastatic recurrence rate was significantly lower in the FOLFIRINOX group (n=20, 52.6%) than in the gemcitabine group (n=22, 78.6%; p=0.001). The rate of adverse events after chemotherapy was significantly higher with FOLFIRINOX than with gemcitabine (43.9%, 20.6%, respectively; p=0.037). Conclusions: FOLFIRINOX provided more clinical and oncological benefit than gemcitabine, with significantly higher overall survival and lower cumulative recurrence rates in BRPC. However, since FOLFIRINOX causes more adverse effects, the regimen should be individualized based on patient’s general condition and clinical status.
참고문헌 (23)
- Gillen S, "Preoperative", neoadjuvant therapy in pancreatic cancer : a systematic review and meta-analysis of response and resection percentages, 2010, pp.7, e1000267~
- 김형석, "Survival outcome and prognostic factors of neoadjuvant treatment followed by resection for borderline resectable pancreatic cancer", Annals of Surgical Treatment and Research, 93(4), pp.186~194 (2017), 대한외과학회
- Katz MH, "Borderline resectable pancreatic cancer : the importance of this emerging stage of disease", J Am Coll Surg, 206, pp.833~848 (2008)
- Jang JY, "Oncological benefits of neoadjuvant chemoradiation with gemcitabine versus upfront surgery in patients with borderline resectable pancreatic cancer : a prospective, randomized, open-label, multicenter phase 2", 3 trial, 2018, pp.268, 215~222
- Nagakawa Y, "Clinical impact of neoadjuvant chemotherapy and chemoradiotherapy in borderline resectable pancreatic cancer : analysis of 884 patients at facilities specializing in pancreatic surgery", Ann Surg Oncol, 26, pp.1629~1636 (2019)
- Mokdad AA, "Neoadjuvant therapy followed by resection versus upfront resection for resectable pancreatic cancer : a propensity score matched analysis", J Clin Oncol, 35, pp.515~522 (2017)
- Russo S, "Neoadjuvant therapy for pancreatic cancer : an ongoing debate", Therap Adv Gastroenterol, 9, pp.429~436 (2016)
- Isaji S, "International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017", Pancreatology, 18, pp.2~11 (2018)
- Conroy T, "FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer", N Engl J Med, 364, pp.1817~1825 (2011)
- Papneja N, "Comparisons of outcomes of real-world patients with advanced pancreatic cancer treated with FOLFIRINOX versus gemcitabine and nab-paclitaxel : a population-based cohort study", Pancreas, 48, pp.920~926 (2019)
- Chapman BC, "Perioperative and survival outcomes following neoadjuvant FOLFIRINOX versus gemcitabine abraxane in patients with pancreatic adenocarcinoma", JOP, 19, pp.75~85 (2018)
- Dhir M, "FOLFIRINOX versus gemcitabine", nab-paclitaxel for neoadjuvant treatment of resectable and borderline resectable pancreatic head adenocarcinoma, 2018, pp.25, 1896~1903
- Tempero MA, "NCCN Guidelines Insights : Pancreatic Adenocarcinoma, Version 1. 2019", J Natl Compr Canc Netw, 17, pp.202~210 (2019)
- Schwartz LH, "RECIST 1. 1 : update and clarification : from the RECIST committee", Eur J Cancer, 62, pp.132~137 (2016)
- Srigley JR, "Protocol for the examination of specimens from patients with carcinoma of the prostate gland", Arch Pathol Lab Med, 133, pp.1568~1576 (2009)
- Groot VP, "Recurrence after neoadjuvant therapy and resection of borderline resectable and locally advanced pancreatic cancer", Eur J Surg Oncol, 45, pp.1674~1683 (2019)
- Schorn S, "Meta-analysis of the impact of neoadjuvant therapy on patterns of recurrence in pancreatic ductal adenocarcinoma", BJS Open, 2, pp.52~61 (2018)
- Dhir M, "Neoadjuvant treatment of pancreatic adenocarcinoma : a systematic review and meta-analysis of 5520 patients", World J Surg Oncol, 15, pp.183~ (2017)
- N Kalimuthu S, "Regression grading in neoadjuvant treated pancreatic cancer : an interobserver study", J Clin Pathol, 70, pp.237~243 (2017)
- Suker M, "FOLFIRINOX for locally advanced pancreatic cancer : a systematic review and patient-level meta-analysis", Lancet Oncol, 17, pp.801~810 (2016)
- Kang J, "Nab-paclitaxel plus gemcitabine versus FOLFIRINOX as the first-line chemotherapy for patients with metastatic pancreatic cancer : retrospective analysis", Invest New Drugs, 36, pp.732~741 (2018)
- Cassinotto C, "An evaluation of the accuracy of CT when determining resectability of pancreatic head adenocarcinoma after neoadjuvant treatment", Eur J Radiol, 82, pp.589~593 (2013)
- Wagner M, "CT evaluation after neoadjuvant FOLFIRINOX chemotherapy for borderline and locally advanced pancreatic adenocarcinoma", Eur Radiol, 27, pp.3104~3116 (2017)