Combination chemotherapy improves survival in patients with pancreatic cancer

In a study of patients with borderline resectable pancreatic cancer, combination chemotherapy with modified FOLFIRINOX before surgery increased survival rate compared favorably to FOLFIRINOX plus hypofractionated radiotherapy. This is in accordance to recent research published in JAMA Oncology.

The multicenter, randomized Phase II Alliance clinical trial established presurgical, or neoadjuvant, FOLFIRINOX as the preferred therapy for these patients.

The objective of this study was to evaluate two neoadjuvant regimens for borderline resectable pancreatic cancer – one that uses FOLFIRINOX chemotherapy and one that uses systemic chemotherapy followed by stereotactic body radiation therapy (SBRT). The goal was to establish either or both treatments as standards of care.

The study included 126 patients treated at 50 sites, randomized to receive systemic therapy or systemic therapy and sequential hypofractionated radiotherapy.

Patients who met radiographic criteria were randomized to eight cycles of FOLFIRINOX chemotherapy or to seven cycles of FOLFIRINOX plus radiation therapy with SBRT or hypofractionated image-guided radiotherapy. Following restaging, patients suitable for surgery underwent pancreatectomy and then received four cycles of adjuvant folinic acid, fluorouracil and oxaliplatin (FOLFOX) chemotherapy.

Among patients who underwent pancreatectomy, complete resection with negative margins was achieved in 88% in the chemotherapy alone arm and 74% in the chemotherapy and radiation arm.

Given these study results, the authors hence believed that all patients with tumors described as borderline resectable should be treated with four months of FOLFIRINOX in anticipation of subsequent pancreatectomy.

Reference:

Katz MHG, Ou FS, Herman JM, Ahmad SA, Wolpin B, Marsh R, Behr S, Shi Q, Chuong M, Schwartz LH, Frankel W, Collisson E, Koay EJ, Hubbard JM, Leenstra JL, Meyerhardt J, O'Reilly E; Alliance for Clinical Trials on Oncology. Alliance for clinical trials in oncology (ALLIANCE) trial A021501: preoperative extended chemotherapy vs. chemotherapy plus hypofractionated radiation therapy for borderline resectable adenocarcinoma of the head of the pancreas. BMC Cancer. 2017 Jul 27;17(1):505. doi: 10.1186/s12885-017-3441-z.