Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer: A new treatment paradigm?

Kathleen K. Christians, Susan Tsai, Anna Mahmoud, Paul Ritch, James P. Thomas, Lauren Wiebe, Tracy Kelly, Beth Erickson, Huamin Wang, Douglas B. Evans, Ben George

Research output: Contribution to journalArticle

Abstract

Background. Borderline resectable pancreatic cancer is best treated by multimodality therapy. FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin) tripled the response rate and significantly increased median survival for patients with advanced pancreatic cancer and shows promise for neoadjuvant use.Toxicity concerns prompteda careful analysis of our initial FOLFIRINOX experience. Methods. All patients diagnosed with borderline resectable, biopsy-proven pancreatic adenocarcinoma treated with neoadjuvant FOLFIRINOX between July 2010 and December 2012 were reviewed. Primary outcome was surgical resectability. Secondary outcomes were treatment-related toxicities and survival. Results. FOLFIRINOX followed by gemcitabine- or capecitabine- based chemoradiation was initiated in 18 patients. The most common grade 3 or 4 toxicities during chemotherapy were gastrointestinal, including nausea/emesis (n = 5), weight loss (n = 3) and diarrhea (n = 2), and hematologic (n = 2; neutropenia); five patients (36%) required a total of six admissions. Neoadjuvant therapy was completed in 15 of 18 patients (83%), and 12 (67%) underwent pancreatectomy (10 Whipple, 2 total pancreatectomy) including portal vein resection/reconstruction in 10 (83%). Disease progression precluded surgery in 6 of the 18 patients (33%). All 12 resected patients had negative (R0) margins. Only 2 of 12 (17%) were node positive (median node count: 26.5 [range: 15-39]). There were no in-hospital or 30-day mortalities and no clinical pancreatic leaksor reoperations. Of the 12 patients who completed all intended therapy, 7 (58.3%) are alive, including 5who have no evidence of disease (medianmonths from diagnosis: 22 months [range: 18-35 months). The six patients who did not complete all planned therapy are deceased (months from diagnosis: 6.9-17.5 months). Conclusion. FOLFIRINOX followed by chemoradiation as neoadjuvant therapy for borderline resectable pancreatic adenocarcinoma is safe, and our initial experience suggests favorable resection rates compared with previous reports in this highrisk patient population.

Original languageEnglish (US)
Pages (from-to)266-274
Number of pages9
JournalOncologist
Volume19
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Pancreatic Neoplasms
Therapeutics
oxaliplatin
irinotecan
Pancreatectomy
Neoadjuvant Therapy
gemcitabine
Adenocarcinoma
Survival
Leucovorin
Portal Vein
Neutropenia
Reoperation
Fluorouracil
Nausea
Vomiting
Disease Progression
Weight Loss
Diarrhea
Biopsy

Keywords

  • Borderline resectable pancreas cancer
  • FOLFIRINOX
  • Neoadjuvant therapy
  • Pancreatic adenocarcinoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Christians, K. K., Tsai, S., Mahmoud, A., Ritch, P., Thomas, J. P., Wiebe, L., ... George, B. (2014). Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer: A new treatment paradigm? Oncologist, 19(3), 266-274. https://doi.org/10.1634/theoncologist.2013-0273

Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer : A new treatment paradigm? / Christians, Kathleen K.; Tsai, Susan; Mahmoud, Anna; Ritch, Paul; Thomas, James P.; Wiebe, Lauren; Kelly, Tracy; Erickson, Beth; Wang, Huamin; Evans, Douglas B.; George, Ben.

In: Oncologist, Vol. 19, No. 3, 2014, p. 266-274.

Research output: Contribution to journalArticle

Christians, KK, Tsai, S, Mahmoud, A, Ritch, P, Thomas, JP, Wiebe, L, Kelly, T, Erickson, B, Wang, H, Evans, DB & George, B 2014, 'Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer: A new treatment paradigm?', Oncologist, vol. 19, no. 3, pp. 266-274. https://doi.org/10.1634/theoncologist.2013-0273
Christians, Kathleen K. ; Tsai, Susan ; Mahmoud, Anna ; Ritch, Paul ; Thomas, James P. ; Wiebe, Lauren ; Kelly, Tracy ; Erickson, Beth ; Wang, Huamin ; Evans, Douglas B. ; George, Ben. / Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer : A new treatment paradigm?. In: Oncologist. 2014 ; Vol. 19, No. 3. pp. 266-274.
@article{cb33eb9671a848b597384514a13a9a22,
title = "Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer: A new treatment paradigm?",
abstract = "Background. Borderline resectable pancreatic cancer is best treated by multimodality therapy. FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin) tripled the response rate and significantly increased median survival for patients with advanced pancreatic cancer and shows promise for neoadjuvant use.Toxicity concerns prompteda careful analysis of our initial FOLFIRINOX experience. Methods. All patients diagnosed with borderline resectable, biopsy-proven pancreatic adenocarcinoma treated with neoadjuvant FOLFIRINOX between July 2010 and December 2012 were reviewed. Primary outcome was surgical resectability. Secondary outcomes were treatment-related toxicities and survival. Results. FOLFIRINOX followed by gemcitabine- or capecitabine- based chemoradiation was initiated in 18 patients. The most common grade 3 or 4 toxicities during chemotherapy were gastrointestinal, including nausea/emesis (n = 5), weight loss (n = 3) and diarrhea (n = 2), and hematologic (n = 2; neutropenia); five patients (36{\%}) required a total of six admissions. Neoadjuvant therapy was completed in 15 of 18 patients (83{\%}), and 12 (67{\%}) underwent pancreatectomy (10 Whipple, 2 total pancreatectomy) including portal vein resection/reconstruction in 10 (83{\%}). Disease progression precluded surgery in 6 of the 18 patients (33{\%}). All 12 resected patients had negative (R0) margins. Only 2 of 12 (17{\%}) were node positive (median node count: 26.5 [range: 15-39]). There were no in-hospital or 30-day mortalities and no clinical pancreatic leaksor reoperations. Of the 12 patients who completed all intended therapy, 7 (58.3{\%}) are alive, including 5who have no evidence of disease (medianmonths from diagnosis: 22 months [range: 18-35 months). The six patients who did not complete all planned therapy are deceased (months from diagnosis: 6.9-17.5 months). Conclusion. FOLFIRINOX followed by chemoradiation as neoadjuvant therapy for borderline resectable pancreatic adenocarcinoma is safe, and our initial experience suggests favorable resection rates compared with previous reports in this highrisk patient population.",
keywords = "Borderline resectable pancreas cancer, FOLFIRINOX, Neoadjuvant therapy, Pancreatic adenocarcinoma",
author = "Christians, {Kathleen K.} and Susan Tsai and Anna Mahmoud and Paul Ritch and Thomas, {James P.} and Lauren Wiebe and Tracy Kelly and Beth Erickson and Huamin Wang and Evans, {Douglas B.} and Ben George",
year = "2014",
doi = "10.1634/theoncologist.2013-0273",
language = "English (US)",
volume = "19",
pages = "266--274",
journal = "Oncologist",
issn = "1083-7159",
publisher = "AlphaMed Press",
number = "3",

}

TY - JOUR

T1 - Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer

T2 - A new treatment paradigm?

AU - Christians, Kathleen K.

AU - Tsai, Susan

AU - Mahmoud, Anna

AU - Ritch, Paul

AU - Thomas, James P.

AU - Wiebe, Lauren

AU - Kelly, Tracy

AU - Erickson, Beth

AU - Wang, Huamin

AU - Evans, Douglas B.

AU - George, Ben

PY - 2014

Y1 - 2014

N2 - Background. Borderline resectable pancreatic cancer is best treated by multimodality therapy. FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin) tripled the response rate and significantly increased median survival for patients with advanced pancreatic cancer and shows promise for neoadjuvant use.Toxicity concerns prompteda careful analysis of our initial FOLFIRINOX experience. Methods. All patients diagnosed with borderline resectable, biopsy-proven pancreatic adenocarcinoma treated with neoadjuvant FOLFIRINOX between July 2010 and December 2012 were reviewed. Primary outcome was surgical resectability. Secondary outcomes were treatment-related toxicities and survival. Results. FOLFIRINOX followed by gemcitabine- or capecitabine- based chemoradiation was initiated in 18 patients. The most common grade 3 or 4 toxicities during chemotherapy were gastrointestinal, including nausea/emesis (n = 5), weight loss (n = 3) and diarrhea (n = 2), and hematologic (n = 2; neutropenia); five patients (36%) required a total of six admissions. Neoadjuvant therapy was completed in 15 of 18 patients (83%), and 12 (67%) underwent pancreatectomy (10 Whipple, 2 total pancreatectomy) including portal vein resection/reconstruction in 10 (83%). Disease progression precluded surgery in 6 of the 18 patients (33%). All 12 resected patients had negative (R0) margins. Only 2 of 12 (17%) were node positive (median node count: 26.5 [range: 15-39]). There were no in-hospital or 30-day mortalities and no clinical pancreatic leaksor reoperations. Of the 12 patients who completed all intended therapy, 7 (58.3%) are alive, including 5who have no evidence of disease (medianmonths from diagnosis: 22 months [range: 18-35 months). The six patients who did not complete all planned therapy are deceased (months from diagnosis: 6.9-17.5 months). Conclusion. FOLFIRINOX followed by chemoradiation as neoadjuvant therapy for borderline resectable pancreatic adenocarcinoma is safe, and our initial experience suggests favorable resection rates compared with previous reports in this highrisk patient population.

AB - Background. Borderline resectable pancreatic cancer is best treated by multimodality therapy. FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin) tripled the response rate and significantly increased median survival for patients with advanced pancreatic cancer and shows promise for neoadjuvant use.Toxicity concerns prompteda careful analysis of our initial FOLFIRINOX experience. Methods. All patients diagnosed with borderline resectable, biopsy-proven pancreatic adenocarcinoma treated with neoadjuvant FOLFIRINOX between July 2010 and December 2012 were reviewed. Primary outcome was surgical resectability. Secondary outcomes were treatment-related toxicities and survival. Results. FOLFIRINOX followed by gemcitabine- or capecitabine- based chemoradiation was initiated in 18 patients. The most common grade 3 or 4 toxicities during chemotherapy were gastrointestinal, including nausea/emesis (n = 5), weight loss (n = 3) and diarrhea (n = 2), and hematologic (n = 2; neutropenia); five patients (36%) required a total of six admissions. Neoadjuvant therapy was completed in 15 of 18 patients (83%), and 12 (67%) underwent pancreatectomy (10 Whipple, 2 total pancreatectomy) including portal vein resection/reconstruction in 10 (83%). Disease progression precluded surgery in 6 of the 18 patients (33%). All 12 resected patients had negative (R0) margins. Only 2 of 12 (17%) were node positive (median node count: 26.5 [range: 15-39]). There were no in-hospital or 30-day mortalities and no clinical pancreatic leaksor reoperations. Of the 12 patients who completed all intended therapy, 7 (58.3%) are alive, including 5who have no evidence of disease (medianmonths from diagnosis: 22 months [range: 18-35 months). The six patients who did not complete all planned therapy are deceased (months from diagnosis: 6.9-17.5 months). Conclusion. FOLFIRINOX followed by chemoradiation as neoadjuvant therapy for borderline resectable pancreatic adenocarcinoma is safe, and our initial experience suggests favorable resection rates compared with previous reports in this highrisk patient population.

KW - Borderline resectable pancreas cancer

KW - FOLFIRINOX

KW - Neoadjuvant therapy

KW - Pancreatic adenocarcinoma

UR - http://www.scopus.com/inward/record.url?scp=84896486447&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896486447&partnerID=8YFLogxK

U2 - 10.1634/theoncologist.2013-0273

DO - 10.1634/theoncologist.2013-0273

M3 - Article

C2 - 24569947

AN - SCOPUS:84896486447

VL - 19

SP - 266

EP - 274

JO - Oncologist

JF - Oncologist

SN - 1083-7159

IS - 3

ER -