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Weniger, Maximilian; Moir, John; Damm, Marko; Maggino, Laura; Kordes, Maximilian; Rosendahl, Jonas; Ceyhan, Güralp O.; Schorn, Stephan; Schmid, Daniel; D'Haese, Jan G.; Werner, Jens; Boeck, Stefan; Kruger, Stephan; Haas, Michael; Roeder, Falk; Friess, Helmut; Chiaro, Marco del; Löhr, Matthias; Tamburrino, Domenico; Falconi, Massimo; Masini, Gaia; Maisonneuve, Patrick; Malleo, Giuseppe; Salvia, Roberto; Bassi, Claudio; Charnley, Richard; Algül, Hana; Schmidt, Melissa; Lange, Sebastian; Michl, Patrick
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... et al., 09/2020, Volume: 20, Issue: 6Journal Article
Neoadjuvant chemotherapy has become a powerful tool to convert borderline resectable (BRPC) and locally advanced pancreatic cancers (LAPC) into a resectable scenario. However, data analyzing the optimal type of therapy are scarce. In the present multicenter retrospective study, we evaluated the influence of FOLFIRINOX (FFX) and gemcitabine (GEM)-based neoadjuvant therapy on patient prognosis. Data on 239 patients from 7 centers across Europe was gathered using an online database. Patients having received their first cycle of chemotherapy for BRPC/LAPC before 06/2017, with a minimum follow-up of 12 months, were included in the intention-to-treat analysis. Patients treated with neoadjuvant FFX (n = 135) or gemcitabine + nab-paclitaxel (GNP) (n = 38) had significantly improved radiological response according to RECIST criteria as compared to single-agent GEM (n = 16), with a partial/complete response of 59.3%, 55.3% and 6.25% respectively (p = 0.001). Treatment with FFX (n = 135) and GNP (n = 38) resulted in higher resection rates compared to GEM (73.3%, 81.6% and 43.8%; p = 0.01 and p = 0.005). Regardless of regimen, patients who were resected had significantly prolonged overall survival compared to non-resected patients (p < 0.01). Complete pathological responses (ypT0 ypN0) were predominantly observed with FFX (p = 0.01). Adjuvant GNP in addition to successful neoadjuvant therapy and surgery resulted in a trend towards improved median survival as compared to postoperative observation (47.0 vs. 30.1 months, p = 0.06). Representing one of the largest studies published so far, our results reveal that patients with BRPC/LAPC should be offered either FFX or GNP to improve chances of resection and with this also survival.
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