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FOLFIRINOX or Gemcitabine-based Chemotherapy for Borderline Resectable and Locally Advanced Pancreatic Cancer: A Multi-institutional, Patient-Level, Meta-analysis and Systematic Review.
Eshmuminov, Dilmurodjon; Aminjonov, Botirjon; Palm, Russell F; Malleo, Giuseppe; Schmocker, Ryan K; Abdallah, Raëf; Yoo, Changhoon; Shaib, Walid L; Schneider, Marcel André; Rangelova, Elena; Choi, Yoo Jin; Kim, Hongbeom; Rose, J Bart; Patel, Sameer; Wilson, Gregory C; Maloney, Sarah; Timmermann, Lea; Sahora, Klaus; Rössler, Fabian; Lopez-Lopez, Víctor; Boyer, Emanuel; Maggino, Laura; Malinka, Thomas; Park, Jeong Youp; Katz, Matthew H G; Prakash, Laura; Ahmad, Syed A; Helton, Scott; Jang, Jin-Young; Hoffe, Sarah E; Salvia, Roberto; Taieb, Julien; He, Jin; Clavien, Pierre-Alain; Held, Ulrike; Lehmann, Kuno.
Affiliation
  • Eshmuminov D; Department of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
  • Aminjonov B; Department of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
  • Palm RF; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
  • Malleo G; Unit of General and Pancreatic Surgery. Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.
  • Schmocker RK; Department of Surgery, The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
  • Abdallah R; Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
  • Yoo C; Hepatogastroenterology and Gastrointestinal Oncology Department, Hôpital Européen Georges-Pompidou, AGEO (Association des Gastro-Enterologues Oncologues), Université de Paris, SIRIC CARPEM, Paris, France.
  • Shaib WL; Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • Schneider MA; Department of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
  • Rangelova E; Department of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
  • Choi YJ; Department of Upper Gastrointestinal Diseases, Karolinska University Hospital and Department of Clinical Science, Intervention, and Technology (CLINTEC) at Karolinska Institute, Stockholm, Sweden.
  • Kim H; Department of Surgery, The Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  • Rose JB; Department of Surgery, Seoul National University College of Medicine, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
  • Patel S; Department of Surgery, Seoul National University College of Medicine, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
  • Wilson GC; Division of Surgical Oncology, Pancreatobiliary Disease Center at UAB, The University of Alabama at Birmingham, Birmingham, USA.
  • Maloney S; Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
  • Timmermann L; Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
  • Sahora K; Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.
  • Rössler F; Department of Surgery, Charité - Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
  • Lopez-Lopez V; Departments of Surgery and Comprehensive Cancer Center, University of Vienna, Medical University of Vienna, Vienna, Austria.
  • Boyer E; Department of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
  • Maggino L; Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain.
  • Malinka T; University of South Florida School of Medicine, Tampa, FL, USA.
  • Park JY; Unit of General and Pancreatic Surgery. Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.
  • Katz MHG; Department of Surgery, Charité - Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
  • Prakash L; Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • Ahmad SA; University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Helton S; University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Jang JY; Division of Surgical Oncology, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
  • Hoffe SE; Section of General, Thoracic and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
  • Salvia R; Department of Surgery, Seoul National University College of Medicine, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
  • Taieb J; Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
  • He J; Unit of General and Pancreatic Surgery. Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.
  • Clavien PA; Hepatogastroenterology and Gastrointestinal Oncology Department, Hôpital Européen Georges-Pompidou, AGEO (Association des Gastro-Enterologues Oncologues), Université de Paris, SIRIC CARPEM, Paris, France.
  • Held U; Department of Surgery, The Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
  • Lehmann K; Department of Surgery and Transplantation, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Ann Surg Oncol ; 30(7): 4417-4428, 2023 Jul.
Article in En | MEDLINE | ID: mdl-37020094
ABSTRACT

BACKGROUND:

Pancreatic cancer often presents as locally advanced (LAPC) or borderline resectable (BRPC). Neoadjuvant systemic therapy is recommended as initial treatment. It is currently unclear what chemotherapy should be preferred for patients with BRPC or LAPC.

METHODS:

We performed a systematic review and multi-institutional meta-analysis of patient-level data regarding the use of initial systemic therapy for BRPC and LAPC. Outcomes were reported separately for tumor entity and by chemotherapy regimen including FOLFIRINOX (FIO) or gemcitabine-based.

RESULTS:

A total of 23 studies comprising 2930 patients were analyzed for overall survival (OS) calculated from the beginning of systemic treatment. OS for patients with BRPC was 22.0 months with FIO, 16.9 months with gemcitabine/nab-paclitaxel (Gem/nab), 21.6 months with gemcitabine/cisplatin or oxaliplatin or docetaxel or capecitabine (GemX), and 10 months with gemcitabine monotherapy (Gem-mono) (p < 0.0001). In patients with LAPC, OS also was higher with FIO (17.1 months) compared with Gem/nab (12.5 months), GemX (12.3 months), and Gem-mono (9.4 months; p < 0.0001). This difference was driven by the patients who did not undergo surgery, where FIO was superior to other regimens. The resection rates for patients with BRPC were 0.55 for gemcitabine-based chemotherapy and 0.53 with FIO. In patients with LAPC, resection rates were 0.19 with Gemcitabine and 0.28 with FIO. In resected patients, OS for patients with BRPC was 32.9 months with FIO and not different compared to Gem/nab, (28.6 months, p = 0.285), GemX (38.8 months, p = 0.1), or Gem-mono (23.1 months, p = 0.083). A similar trend was observed in resected patients converted from LAPC.

CONCLUSIONS:

In patients with BRPC or LAPC, primary treatment with FOLFIRINOX compared with Gemcitabine-based chemotherapy appears to provide a survival benefit for patients that are ultimately unresectable. For patients that undergo surgical resection, outcomes are similar between GEM+ and FOLFIRINOX when delivered in the neoadjuvant setting.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pancreatic Neoplasms / Gemcitabine Type of study: Clinical_trials / Systematic_reviews Limits: Humans Language: En Journal: Ann Surg Oncol Journal subject: NEOPLASIAS Year: 2023 Type: Article Affiliation country: Switzerland
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pancreatic Neoplasms / Gemcitabine Type of study: Clinical_trials / Systematic_reviews Limits: Humans Language: En Journal: Ann Surg Oncol Journal subject: NEOPLASIAS Year: 2023 Type: Article Affiliation country: Switzerland