Pathologic Major Response After FOLFIRINOX is Prognostic for Patients Secondary Resected for Borderline or Locally Advanced Pancreatic Adenocarcinoma: An AGEO-FRENCH, Prospective, Multicentric Cohort.
OBJECTIVE
In view of increased response rates and survivals in patients with metastatic pancreatic adenocarcinoma (PAC) with FOLFIRINOX, many centers proposed this regimen as induction chemotherapy for borderline (BR) or locally advanced (LA) PAC. The aim of this study was to assess surgical and oncological outcomes of patients who underwent resection after induction FOLFIRINOX therapy.


METHODS
We prospectively identified surgical consecutive BR or LA PAC patients after induction FOLFIRINOX in 20 observational French centers between November 2010 and December 2013. Two independent experts retrospectively evaluated initial CT scan for central review.


RESULTS
Eighty patients were included, 47 had BR and 33 had LA PAC. Median number of FOLFIRINOX cycles was 6 (range 1-30) and 65 % of patients received chemoradiation. The 30-day-mortality, major complications, and symptomatic pancreatic fistula rates were 2.5, 22.5, and 4 %, respectively. R0 resection was achieved in 84 %. After a median follow-up of 38.2 months since diagnosis, disease-free survival (DFS) was 17.16 months. The overall survival rates at 12 and 24 months were 92 and 81 %, respectively. A 26 % (n = 21) pathologic major response (pMR) rate was reached. In univariate and multivariate analysis, pMR was a prognostic factor for DFS (hazard ratio 0.33; P = 0.01 and hazard ratio 0.38; P = 0.035).


CONCLUSIONS
Resection after induction FOLFIRINOX is safe and associated with similar or better outcomes as upfront surgery in patients with PAC. A pMR was observed in 26 % of cases and was prognostic of DFS. This therapeutic design should be investigated in prospective studies.
Department of Digestive and Hepatobiliary Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France.
Daniel
D
Pietrasz
Hepatogastroenterology Department, Antoine Béclère Hospital, Clamart, France.
Lysiane
L
Marthey
Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France.
Mathilde
M
Wagner
Hepato-Gastroenterology Department, Saint-André Hospital, Bordeaux, France.
Jean-Frédéric
JF
Blanc
Department of Visceral and Transplant Surgery, Saint-André Hospital, Bordeaux, France.
Christophe
C
Laurent
Surgical Oncology Department, Institut Paoli Calmette, Marseille, France.
Olivier
O
Turrini
Oncology Department, Institut Paoli Calmette, Marseille, France.
Jean Luc
JL
Raoul
Gastroenterology and Digestive Oncology Department, Bordeaux South Hospital, Bordeaux, France.
Eric
E
Terrebonne
Pancreato-Gastroenterology Department, Beaujon Hospital, Clichy, France.
Olivia
O
Hentic
Hepatogastroenterology and Digestive Oncology Department, Georges Pompidou Hospital, Paris, France.
Isabelle
I
Trouilloud
Gastroenterology Unit, Cochin Hospital, Paris, France.
Romain
R
Coriat
Department of Digestive Surgery, Nantes Hospital, Nantes, France.
Nicolas
N
Regenet
Hematology-Oncology Department, Paul Brousse Hospital, Villejuif, France.
Pasquale
P
Innominato
Hepatogastroenterology and Digestive Oncology Department, Georges Pompidou Hospital, Paris, France.
Julien
J
Taieb
Liver Transplant Center, Paul Brousse Hospital, Villejuif, France.
Antonio Sa
AS
Cunha
Gastroenterology and Digestive Oncology Department, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France. jean-baptiste.bachet@aphp.fr.
Jean Baptiste
JB
Bachet
D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D060828:Induction Chemotherapy; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin