Efficacy and safety of neoadjuvant FOLFIRINOX for borderline resectable pancreatic adenocarcinoma: improved efficacy compared with gemcitabine-based regimen

// Changhoon Yoo 1, * , Jihoon Kang 1, * , Kyu-Pyo Kim 1 , Jae-Lyun Lee 1 , Baek-Yeol Ryoo 1 , Heung-Moon Chang 1 , Sang Soo Lee 2 , Do Hyun Park 2 , Tae Jun Song 2 , Dong Wan Seo 2 , Sung Koo Lee 2 , Myung-Hwan Kim 2 , Jin-Hong Park 3 , Dae Wook Hwang 4 , Ki Byung Song 4 , Jae Hoon Lee 4 and Song Cheol Kim 4 1 Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 2 Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 3 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 4 Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea * C. Yoo and J. Kang contributed equally to this work and should be considered co-first authors Correspondence to: Kyu-Pyo Kim, email: kkp1122@amc.seoul.kr Song Cheol Kim, email: drksc@amc.seoul.kr Keywords: pancreatic cancer, chemotherapy, neoadjuvant, FOLFIRINOX Received: November 17, 2016 Accepted: February 06, 2017 Published: May 16, 2017 ABSTRACT Borderline resectable pancreatic cancer (BRPC) is a potentially resectable disease but is associated with poorer survival compared to primary resectable disease. There has been no prospective trial that compare the efficacy of FOLFIRNOX and gemcitabine-based regimen for BRPC. Between February 2013 and December 2014, 18 patients with BRPC receiving FOLFIRINOX were reviewed retrospectively. For comparative analysis, data for all BRPC patients (n=18) in our previous phase 2 study of neoadjuvant fixed-dose rate-gemcitabine plus capecitabine were pooled. Patients received a median 6 cycles (range, 3-13) of FOLFIRINOX. Surgical resection was performed in 12 patients (67%) and R0 resection in 9 patients. Median progression-free survival (PFS) and overall survival (OS) were 16.8 (95% confidence interval [CI], 9.4-24.2) and 21.2 (95% CI, 14.2-28.2) months, respectively. Patients who underwent surgical resection showed significantly better PFS (p=0.01) and OS (p=0.003) than those unresected. In the exploratory analysis, patients receiving FOLFIRINOX showed significantly longer PFS compared to those receiving fixed-dose rate-gemcitabine plus capecitabine (median 16.8 months [95% CI, 9.4-24.2] vs. 6.5 months [1.6-11.3]; p = 0.04). There was a trend toward improved OS in patients who received FOLFIRINOX (median 21.2 months [95% CI, 14.2-28.2]) compared to those who received fixed-dose rate-gemcitabine plus capecitabine (13.6 months [11.8-15.4]; p=0.12). FOLFIRINOX was feasible and effective as neoadjuvant chemotherapy for patients with BRPC and may have improved efficacy compared to a gemcitabine-based regimen.