Resectability After First-Line FOLFIRINOX in Initially Unresectable Locally Advanced Pancreatic Cancer: A Single-Center Experience.
BACKGROUND
FOLFIRINOX is an active but relatively toxic chemotherapeutic regimen for patients with metastatic pancreatic ductal adenocarcinoma (PDAC). The increased frequency of responding tumors shift interest to neoadjuvant approaches. We report our institutional experience with FOLFIRINOX for therapy-naïve patients with locally advanced and initially unresectable PDAC.


METHODS
All patients with unresectable locally advanced PDAC who underwent treatment with FOLFIRINOX at a single center between 2011 and 2014 were identified and evaluated retrospectively regarding chemotherapy response, toxicity, conversion to resectability, and survival. Resectability, response to chemotherapy, and postoperative complications were reported according to NCCN-guidelines, RECIST-criteria, and Clavien-Dindo-classification, respectively.


RESULTS
Overall, 14 patients received FOLFIRINOX as first-line therapy for locally advanced and unresectable PDAC. Fifty-seven percent of the patients had severe tumor-related comorbidities at the time of diagnosis, and in 86 %, dose reduction due to toxicity was necessary during a median of seven cycles. Nevertheless, only one patient had progressive disease during FOLFIRINOX, whereas the others experienced stable disease (n = 6) or partial remission (n = 6; no restaging in one patient). Oncological tumor resection was possible in 4 patients (29 % of all patients) with no postoperative mortality and only one grade 2 surgical complication. After a median follow-up of 10 months, 4 of the 14 patients were still in remission, 5 were alive with stable disease under ongoing systemic chemotherapy, and 5 died tumor-related.


CONCLUSIONS
FOLFIRINOX is a powerful first-line regimen that leads to resectability in a substantial portion of patients with initially unresectable pancreatic cancer.
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Ulrich
U
Nitsche
Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Patrick
P
Wenzel
Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Jens T
JT
Siveke
Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Rickmer
R
Braren
Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Konstantin
K
Holzapfel
Institute of Pathology, Technische Universität München, Munich, Germany.
Anna M
AM
Schlitter
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Christian
C
Stöß
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Bo
B
Kong
Institute of Pathology, Heinrich Heine University, Düsseldorf, Germany.
Irene
I
Esposito
Department of Surgery, Koc University School of Medicine, Istanbul, Turkey.
Mert
M
Erkan
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Christoph W
CW
Michalski
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Helmut
H
Friess
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. kleeff@tum.de.
Jörg
J
Kleeff
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin