FOLFIRINOX as Initial Treatment for Localized Pancreatic Adenocarcinoma: A Retrospective Analysis by the Trans-Atlantic Pancreatic Surgery (TAPS) Consortium
Menée à partir de données portant sur 1 835 patients atteints d'un adécocarcinome du pancréas de stade localisé, cette étude internationale rétrospective évalue l'efficacité, du point de vue de la survie globale, d'une chimiothérapie de première ligne de type FOLFORINOX
BACKGROUND : Large pragmatic studies of patients who received (m)FOLFIRINOX as initial treatment for localized pancreatic ductal adenocarcinoma (PDAC) are lacking. This study aimed to provide realistic estimates of oncologic outcomes in these patients.
METHODS : This international retrospective cohort study included all consecutive patients presenting with localized PDAC who received at least one cycle of (m)FOLFIRINOX as initial treatment in five referral centers from the United States and the Netherlands (2012–2019). Primary outcome was median overall survival (OS), calculated from the date of tissue diagnosis, assessed using Kaplan-Meier estimates. Log-rank test was used to compare OS between groups. A Cox proportional hazards regression model was used to assess prognostic baseline factors for OS. All statistical tests were 2-sided.
RESULTS : Overall, 1,835 patients were included, of whom 958 (52.2%) had locally advanced (LA), 531 (28.9%) had borderline resectable (BR), and 346 (18.9%) had potentially resectable (PR) PDAC. The median number of (m)FOLFIRINOX cycles was 6 (interquartile range = 4–8). Subsequent treatment included second chemotherapy (12.9%), radiotherapy (49.0%), and resection (37.9%). Resection rate was 17.6% for LA, 53.1% for BR, and 70.5% for PR PDAC (p < .001). Margin-negative resection rate (>1mm) was 55.2% for LA, 62.6% for BR, and 79.2% for PR PDAC (p < .001). Median OS was 18.7 months (95% confidence interval [CI] = 17.7–19.9) for LA, 23.2 months (95% CI = 21.0–25.7) for BR, and 31.2 months (95% CI = 26.2–36.6) for PR PDAC (p < .001). Median OS for 695 patients who underwent a resection was 38.3 months (95% CI = 36.1–42.0). Independent prognostic factors at baseline for worse OS were more advanced stage, worse performance status, baseline CA 19–9 > 500 U/mL, and BMI ≤18.5 kg/m2.
CONCLUSIONS : This large international cohort study provides realistic estimates of resection rates and survival in patients with LA, BR, and PR PDAC who started (m)FOLFIRINOX treatment in PDAC referral centers.
Journal of the National Cancer Institute , résumé, 2021