K. Ang1, N. Goel1, M. Kilcoyne1, A. Nadler1, W. H. Ward1, J. Farma1, A. Karachristos1, N. Esnaola1, J. P. Hoffman1, S. Reddy1 1Fox Chase Cancer Center,Department Of Surgical Oncology,Philadelphia, PENNSYLVANIA, USA
Introduction: While there is growing interest in the role of neoadjuvant therapy (including chemotherapy and chemoradiation) in patients with localized, borderline resectable (BR), and locally advanced (LA) pancreatic adenocarcinoma, the relative value of alternative chemotherapeutic regimens remains to be defined. The objective of this study was to evaluate biochemical and oncologic outcomes (serum CA19-9 response, R0 resection rate, overall survival [OS]) associated with alternative preoperative chemotherapeutic regimens (FOLFIRINOX versus Gemcitabine [Gem]-based chemotherapy) in patients with localized/BR/LA pancreatic adenocarcinoma treated with total neoadjuvant therapy (defined as neoadjuvant systemic chemotherapy followed by chemoradiation).
Methods: We retrospectively analyzed patients with localized/BR/LA pancreatic adenocarcinoma treated with total neoadjuvant therapy and subsequent surgical resection treated at our institution from 2000-2017. Clinical and pathologic data was directly abstracted from the clinical record.
Comparative analyses were performed with chi-square tests; survival outcomes were assessed using the Kaplan-Meier product limit method and compared using log rank tests.
Results: Sixty-nine patients completed TNT prior to surgical resection: 15 patients received FOLFIRINOX, while 54 patients received Gem-based chemotherapy. 20 of patients had localized disease; 49 had BR or LA disease at presentation, respectively. Overall, the median age was 64 years old (range 38 – 82); 50.7% of patients were male, 88.4% were Caucasian, 8.7% were Black/African American, and 2.9% were Asian. The median serum CA19-9 level at presentation was 173.5 (normal range, 0-35 U/mL) for the group that received FOLFIRINOX vs. 127 for the group that received Gem-based chemotherapy (p=0.352). Among patients who received FOLFIRINOX, 53% experienced a >50% decrease in serum CA19-9 after TNT, 13.3% experienced a <50% decrease, and 6.6% experienced no change (or an increase). Among patients who received Gem-based chemotherapy, 50% experienced a >50% decrease in serum CA19-9 after TNT, 14.8% experienced a <50% decrease, and 9.3% experienced no change (or an increase). 93% vs. 83% percent of patients who received FOLFIRINOX vs. Gem-based chemotherapy subsequently underwent an R0 resection (p=0.33). Median OS and 3-year survival of patients who received FOLFIRINOX were 47.6 months and 48%, respectively; in comparison, median OS and 3-year survival of patients who received Gem-based chemotherapy respectively (p=0.173).
Conclusions: Among patients with localized/BR/LA pancreatic adenocarcinoma, treatment with FOLFIRINOX vs. Gem-based chemotherapy within the context of TNT results in comparable biochemical and oncologic outcomes. Our data suggests that (at the current time) the choice of neoadjuvant chemotherapeutic regimens (as part of TNT) should ideally be based on performance status at presentation and potential toxicity.