Neoadjuvant FOLFIRINOX followed by gemcitabine based chemoradiation as a treatment paradigm for Borderline resectable pancreatic adenocarcinoma

Abstract

Author(s): Rasha Abd El-Ghany Khedr*, Mohamed Ghazaly, Amira Khedr and Mohamed Fathy Sheta

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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