Pancreatic cancer: after neoadjuvant FOLFIRINOX, adjuvant chemo may offer benefit

  • van Roessel S & al.
  • JAMA Oncol
  • 10.09.2020

  • von Jim Kling
  • Studien – kurz & knapp
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Takeaway

  • After neoadjuvant FOLFIRINOX treatment, adjuvant chemotherapy is associated with benefit only in patients with node-positive disease.
  • Adjuvant FOLFIRINOX and gemcitabine chemotherapy were associated with survival benefit.

Why this matters

  • This is the first large study of patients receiving adjuvant chemotherapy after neoadjuvant FOLFIRINOX.

Study design

  • International cohort study (N=520).
  • Funding: European-African Hepato-Pancreato-Biliary Association.

Key results

  • 66.0% of patients received adjuvant chemotherapy: 19.8% FOLFIRINOX, 58.6% gemcitabine-based chemotherapy, 4.1% capecitabine, 13.1% a combination or other agents, 4.4% unknown.
  • Median of 6 cycles of FOLFIRINOX (folinic acid, fluorouracil, irinotecan, and oxaliplatin).
  • Median follow-up, 35 months.
  • Overall median OS, 38 months after diagnosis and 31 months after surgery.
  • There was no significant difference in median OS between patients who received adjuvant chemotherapy and those who did not (HR, 0.99; P=.93).
  • Subgroup analyses showed an association between survival and adjuvant chemotherapy in pathology-proven node-positive disease (HR, 0.41; P=.004), but not in node-negative disease (HR, 0.85; P=.73).
  • By type of adjuvant therapy, improved survival was associated with gemcitabine (27 vs 13 months; 95% CI, 9-20) and FOLFIRINOX (28 vs 13 months; 95% CI, 23 to not reached).

Limitations

  • Retrospective design.