Long-Duration Neoadjuvant Therapy with FOLFIRINOX Yields Favorable Outcomes for Patients Who Undergo Surgery for Pancreatic Cancer

Phoebe N Miller ^1,2,3, Fernanda Romero-Hernandez ^1,2, Lucia Calthorpe ^1,2

¹Division of Surgical Oncology, Section of Hepatopancreaticobiliary Surgery, University of California, San Francisco, San Francisco, CA, USA.
²UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
³Division of General Surgery, University of California San Francisco, San Francisco, CA, USA.
⁴Department of Surgery, St. Elizabeth's Medical Center, Boston, MA, USA.
⁵Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
⁶Department of Pathology, University of California, San Francisco, San Francisco, CA, USA.
⁷Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁸Division of Surgical Oncology, Section of Hepatopancreaticobiliary Surgery, University of California, San Francisco, San Francisco, CA, USA. Eric.Nakakura@ucsf.edu.
⁹UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA. Eric.Nakakura@ucsf.edu.

⁰Division of Surgical Oncology, Section of Hepatopancreaticobiliary Surgery, University of California, San Francisco, San Francisco, CA, USA.

Annals of Surgical Oncology +

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June 15, 2024

View abstract on PubMed

Summary

Long-duration neoadjuvant chemotherapy, particularly FOLFIRINOX, before surgery for pancreatic cancer (PDAC) leads to similar survival outcomes regardless of initial resectability. This approach achieves favorable surgical results and R0 resection rates.

Area Of Science

Oncology
Surgical Oncology
Gastrointestinal Oncology

Background

Pancreatic ductal adenocarcinoma (PDAC) has a high mortality rate, with over 50,000 deaths estimated in 2023.
Neoadjuvant therapy is recommended for borderline resectable and locally advanced PDAC, with growing evidence for resectable cases.
Neoadjuvant chemotherapy may improve complete resection rates and identify aggressive tumor biology.

Purpose Of The Study

To evaluate surgical outcomes after long-duration neoadjuvant chemotherapy for PDAC.
To compare survival in PDAC patients based on initial resectability status after neoadjuvant therapy.

Main Methods

Retrospective analysis of single-institution data.
Inclusion of patients receiving long-duration neoadjuvant chemotherapy (median 10 cycles FOLFIRINOX, 7 cycles gemcitabine-based).

Main Results

The R0 resection rate was 76% in patients treated predominantly with FOLFIRINOX (85%) without radiation.
Median overall survival (OS) was 41 months.
No significant difference in OS was observed among patients with initially resectable, borderline resectable, or locally advanced PDAC.

Conclusions

Long-duration neoadjuvant FOLFIRINOX therapy followed by surgical resection yields favorable surgical outcomes.
Survival is comparable across different pretreatment resectability statuses in PDAC patients receiving neoadjuvant FOLFIRINOX.
Neoadjuvant chemotherapy is a viable strategy for improving outcomes in PDAC patients.