Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer: a systematic review and patient-level meta-analysis

Janssen, Q. P. et al. (2019) Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer: a systematic review and patient-level meta-analysis. Journal of the National Cancer Institute, 111(8), pp. 782-794. (doi: 10.1093/jnci/djz073) (PMID:31086963) (PMCID:PMC6695305)

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Abstract

Background: FOLFIRINOX is a standard treatment for metastatic pancreatic cancer patients. The effectiveness of neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer (BRPC) remains debated. Methods: We performed a systematic review and patient-level meta-analysis on neoadjuvant FOLFIRINOX in patients with BRPC. Studies with BRPC patients who received FOLFIRINOX as first-line neoadjuvant treatment were included. Primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), resection rate, R0-resection rate, and grade 3-4 adverse events. Patient-level survival outcomes were obtained from authors of the included studies and analyzed using the Kaplan-Meier method. Results: We included 24 studies (8 prospective, 16 retrospective), comprising 313 (38.1%) BRPC patients treated with FOLFIRINOX. Most studies (n=20) presented intention-to-treat results. The median number of administered neoadjuvant FOLFIRINOX cycles ranged from 4 to 9. The resection rate was 67.8% (95% CI: 60.1 – 74.6), the R0-resection rate was 83.9% (95% CI: 76.8 – 89.1). The median OS varied from 11.0 to 34.2 months across studies. Patient-level survival data was obtained for 20 studies representing 283 BRPC patients. Patient-level median OS was 22.2 months (95% CI: 18.8 – 25.6), patient-level median PFS was 18.0 months (95% CI: 14.5 – 21.5). Pooled event rates for grade 3-4 adverse events were highest for neutropenia (17.5 per 100 patients, 95% CI: 10.3 – 28.3), diarrhea (11.1 per 100 patients, 95% CI: 8.6 – 14.3), and fatigue (10.8 per 100 patients, 95% CI 8.1 – 14.2). No deaths were attributed to FOLFIRINOX. Conclusion: This patient-level meta-analysis of BRPC patients treated with neoadjuvant FOLFIRINOX showed a favorable median OS, resection rate, and R0-resection rate. These results need to be assessed in a randomized trial.

Item Type:Articles
Additional Information:Thiswork was supported by the Dutch Cancer Society (grant number 2017 - 109555) and The Netherlands Organisation for Health Research and Development (grant number 2017 - 8430041 08).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Jamieson, Professor Nigel and McKay, Mr Colin
Authors: Janssen, Q. P., Buettner, S., Suker, M., Beumer, B. R., Addeo, P., Bachellier, P., Bahary, N., Bekaii-Saab, T., Bali, M. A., Besselink, M. G., Boone, B. A., Chau, I., Clarke, S., Dillhoff, M., El-Rayes, B. F., Frakes, J. M., Grose, D., Hosein, P. J., Jamieson, N. B., Javed, A. A., Khan, K., Kim, K.-p., Kim, S. C., Kim, S. S., Ko, A. H., Lacy, J., Margonis, G. A., McCarter, M. D., McKay, C. J., Mellon, E. A., Moorcraft, S. Y., Okada, K.-i., Paniccia, A., Parikh, P. J., Peters, N. A., Rabl, H., Samra, J., Tinchon, C., van Tienhoven, G., van Veldhuisen, E., Wang-Gillam, A., Weiss, M. J., Wilmink, J. W., Yamaue, H., Homs, M. Y.V., van Eijck, C. H.J., Katz, M. H.G., and Koerkamp, B. G.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
Journal Name:Journal of the National Cancer Institute
Publisher:Oxford University Press
ISSN:0027-8874
ISSN (Online):1460-2105
Published Online:14 May 2019
Copyright Holders:Copyright © The Author(s) 2019
First Published:First published in Journal of the National Cancer Institute 111(8):782-794
Publisher Policy:Reproduced under a Creative Commons license

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