Proper adjuvant therapy in patients with borderline resectable and locally advanced pancreatic cancer who had received neoadjuvant FOLFIRINOX

Jin Ho Choi; Min Kyu Kim; Sang Hyub Lee; Jin Woo Park; Namyoung Park; In Rae Cho; Ji Kon Ryu; Yong-Tae Kim; Jin-Young Jang; Wooil Kwon; Hongbeom Kim; Woo Hyun Paik

doi:10.3389/fonc.2022.945829

Proper adjuvant therapy in patients with borderline resectable and locally advanced pancreatic cancer who had received neoadjuvant FOLFIRINOX

Front Oncol. 2022 Sep 20:12:945829. doi: 10.3389/fonc.2022.945829. eCollection 2022.

Authors

Affiliations

¹ Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
² The Armed Forces Medical Command, Ministry of National Defense, Gyeonggi-do, South Korea.
³ Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
⁴ Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

Abstract

Background: The complete resection rate of pancreatic cancer has increased because of the advent of efficacious first-line treatments for unresectable pancreatic cancer. Still, strategies regarding adjuvant therapy after neoadjuvant FOLFIRINOX treatment remain to be established.

Methods: Data on 144 patients with borderline resectable and locally advanced pancreatic cancer who underwent resection after neoadjuvant FOLFIRINOX between January 2013 and April 2021 were retrospectively reviewed.

Results: Among the study patients, 113 patients (78.5%) were diagnosed with borderline resectable pancreatic cancer and 31 patients (21.5%) were diagnosed with locally advanced pancreatic cancer. Seventy-five patients (52.1%) received radiotherapy before surgery. After radical resection, 84 patients (58.3%) received 5-fluorouracil-based adjuvant therapy and 60 patients (41.7%) received non-5-fluorouracil-based adjuvant therapy. Adjuvant therapy with 5-fluorouracil-based regimen [hazard ratio (HR), 0.43 (95% CI, 0.21-0.87); p = 0.019], preoperative assessment as locally advanced pancreatic cancer [HR, 2.87 (95% CI, 1.08-7.64); p = 0.035], positive resection margin [HR, 3.91 (95% CI, 1.71-8.94); p = 0.001], and presence of pathologic lymph node involvement [HR, 2.31 (95% CI, 1.00-5.33), p = 0.050] were associated with decreased recurrence-free survival. Adjuvant therapy with 5-fluorouracil-based regimen [HR, 0.35 (95% CI, 0.15-0.84); p = 0.018], positive resection margin [HR, 4.14 (95% CI, 1.75-9.78); p = 0.001], presence of pathologic lymph node involvement [HR, 3.36 (95% CI, 1.23-9.15); p = 0.018], poor differentiation [HR, 5.69 (95% CI, 1.76-18.36); p = 0.004], and dose reduction during adjuvant therapy [HR, 1.78 (95% CI, 1.24-24.37); p = 0.025] were associated with decreased overall survival.

Conclusions: The 5-fluorouracil-based adjuvant therapy seems to be the proper adjuvant therapy for patients who received neoadjuvant FOLFIRINOX for borderline resectable and locally advanced pancreatic cancer.

Keywords: FOLFIRINOX; adjuvant chemo- therapy; borderline resectable pancreatic adenocarcinoma; locally advanced pancreatic cancer (LAPC); neoadjuvant therapy; pancreatic cancer.