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FOLFIRINOX Versus Gemcitabine/Nab-Paclitaxel for Neoadjuvant Treatment of Resectable and Borderline Resectable Pancreatic Head Adenocarcinoma

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Both FOLFIRINOX and gemcitabine/nab-paclitaxel (G-nP) are used increasingly in the neoadjuvant treatment (NAT) of pancreatic ductal adenocarcinoma (PDA). This study aimed to compare neoadjuvant FOLFIRINOX and G-nP in the treatment of resectable (R) and borderline resectable (BR) head PDA.

Methods

A single-institution retrospective review of R and BR patients undergoing pancreaticoduodenectomy after NAT with FOLFIRINOX or G-nP was performed. Comparative analysis was performed using inverse-probability-weighted (IPW) estimators. The end points of the study were overall survival (OS) and an 80% reduction in CA19-9 with NAT.

Results

In this study, 193 patients were analyzed, with 73 patients receiving FOLFIRINOX and 120 patients receiving G-nP. The median OS was 38.7 months for FOLFIRINOX versus 28.6 months for G-nP (p = 0.214). The patients who received FOLFIRINOX were younger and had fewer comorbidities, more BR disease, and larger tumors than those treated with G-nP (all p < 0.05). The two regimens were equally effective in achieving an 80% decline in CA19-9 (p = 0.8). The R0 resection rates were similar (80%), but FOLFIRINOX was associated with a reduction in pN1 disease (56% vs. 72%; p = 0.028). The receipt of adjuvant therapy was similar (74 vs. 75%; p = 0.79). In the Cox regression analysis with adjustment for baseline and treatment-related variables (FOLFIRINOX vs. G-nP, age, gender, computed tomography (CT) tumor size, BR vs. R, pre-NAT CA19-9), regimen type was not associated with a survival benefit. In the IPW analysis of 166 patients, however, the average treatment effect of FOLFIRINOX was to increase OS by 4.9 months compared with G-nP (p = 0.012).

Conclusions

Both FOLFIRINOX and G-nP are viable options for neoadjuvant treatment of PDA. In this study, neoadjuvant FOLFIRINOX was associated with a 4.9-month improvement in survival compared with G-nP after adjustment for covariates.

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Authors and Affiliations

  1. Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA

    Mashaal Dhir MD

  2. Department of Biostatistics and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    Mazen S. Zenati MD, PhD

  3. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Ahmad Hamad MD, Melissa E. Hogg MD, Herbert J. Zeh III MD & Amer H. Zureikat MD, FACS

  4. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Aatur D. Singhi MD

  5. Department of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Nathan Bahary MD

  6. Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Amer H. Zureikat MD, FACS

Authors
  1. Mashaal Dhir MD
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  2. Mazen S. Zenati MD, PhD
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  3. Ahmad Hamad MD
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  4. Aatur D. Singhi MD
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  5. Nathan Bahary MD
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  6. Melissa E. Hogg MD
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  7. Herbert J. Zeh III MD
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  8. Amer H. Zureikat MD, FACS
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Correspondence to Amer H. Zureikat MD, FACS.

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Dhir, M., Zenati, M.S., Hamad, A. et al. FOLFIRINOX Versus Gemcitabine/Nab-Paclitaxel for Neoadjuvant Treatment of Resectable and Borderline Resectable Pancreatic Head Adenocarcinoma. Ann Surg Oncol 25, 1896–1903 (2018). https://doi.org/10.1245/s10434-018-6512-8

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  • DOI: https://doi.org/10.1245/s10434-018-6512-8

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