Neoadjuvant FOLFIRINOX followed by gemcitabine based chemoradiation as a treatment paradigm for Borderline resectable pancreatic adenocarcinoma
Background: The patient’s outcome for Borderline Resectable Pancreatic Adenocarcinoma (BRPC) is dismal. We aimed to evaluate FOLFIRINOX efficacy/toxicity as a neoadjuvant chemotherapy followed by gemcitabinebased chemoradiation in (BRPC).
Methods: 23 chemotherapy/radiotherapy-naïve (BRPC) patients received six months of biweekly FOLFIRINOX chemotherapy. After FOLFIRINOX (12 times), protocol-based concurrent gemcitabine/IMRT external beam radiation therapy was delivered. Gemcitabine was administered on days (1/8/22 and 29). One month later, patients without progressive disease or unacceptable toxicity continued treatment for additional 2 cycles of gemcitabine infusions. The primary endpoint was R0 resection rates. Secondary endpoints were the Overall Response Rate (ORR), progression-free survival, overall survival, and toxicity.
Results: The ORR was 43.5% and the disease control rate was 82.1%. Nine patients had stable disease and 4 patients had disease progression. The resection rate was 60.9%, with R0 resections at 43.5%. Median PFS and OS were 16 and 23 months, respectively.1-year and 2-year OS rates were 74.7% and 49.6% respectively. 1-year and 2-year PFS rate was 54.9% and 35.3% respectively. Neutropenia (43.5%), was and Diarrhoea (17.4%), nausea (39.1%) were the most common grade (3-4) haematological and nonhaematological toxicity, respectively.
Conclusion: FOLFIRINOX followed by gemcitabine-based chemoradiation, was a more efficient regimen with a manageable toxicity profile in (BRPC).
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Prof. Elhadi Miskeen
Obstetrics and Gynaecology Faculty of Medicine, University of Bisha, Saudi Arabia
Ahmed Hussien Alshewered
University of Basrah College of Medicine, Iraq
Department of Electronics and Communication Engineering SRM University – AP, Andhra Pradesh
Supervisor of Biochemistry Lab and PhD. students of Faculty of Science, Department of Chemistry and Department of Chemis
Fava Maria Giovanna
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