AUTHOR=Choi Jin Ho , Kim Min Kyu , Lee Sang Hyub , Park Jin Woo , Park Namyoung , Cho In Rae , Ryu Ji Kon , Kim Yong-Tae , Jang Jin-Young , Kwon Wooil , Kim Hongbeom , Paik Woo Hyun 

TITLE=Proper adjuvant therapy in patients with borderline resectable and locally advanced pancreatic cancer who had received neoadjuvant FOLFIRINOX

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.945829

DOI=10.3389/fonc.2022.945829

ISSN=2234-943X

ABSTRACT=Background: The complete resection rate of pancreatic cancer has increased because of the advent of efficacious first-line treatments for unresectable pancreatic cancer. Still, strategies regarding adjuvant therapy after neoadjuvant FOLFIRINOX treatment remain to be established.

Methods: Data on 144 borderline resectable and locally advanced pancreatic cancer who underwent resection after neoadjuvant FOLFIRINOX between Jan 2013 and Apr 2021 were retrospectively reviewed.

Results: Among the study patients, 113 patients (78.5%) were diagnosed with borderline resectable pancreatic cancer, and 31 patients (21.5%) were diagnosed with locally advanced pancreatic cancer. Seventy-five patients (52.1%) received radiotherapy before surgery. After radical resection, 84 patients (58.3%) received 5-fluorouracil-based adjuvant therapy and 60 patients (41.7%) received non 5-fluorouracil-based adjuvant therapy. Adjuvant therapy with 5-fluorouracil-based regimen (Hazard ratio (HR), 0.43 [95%CI, 0.21–0.87], p=0.019), preoperative assessment as locally advanced pancreatic cancer (HR, 2.87 [95%CI, 1.08–7.64], p=0.035), positive resection margin (HR, 3.91 [95%CI, 1.71–8.94], p=0.001), and presence of pathologic lymph node involvement (HR, 2.31 [95%CI, 1.00–5.33], p=0.050) were associated with decreased recurrence free survival. Adjuvant therapy with 5-fluorouracil-based regimen (HR, 0.35 [95%CI, 0.15–0.84], p=0.018), positive resection margin (HR, 4.14 [95%CI, 1.75–9.78], p=0.001), presence of pathologic lymph node involvement (HR, 3.36 [95% CI, 1.23–9.15], p=0.018), poor differentiation (HR, 5.69 [95%CI, 1.76–18.36], p=0.004), and dose reduction during adjuvant therapy (HR, 1.78 [95%CI, 1.24–24.37], p=0.025) were associated with decreased overall survival. 

Conclusions: 5-fluorouracil-based adjuvant therapy seems to be the proper adjuvant therapy for patients who received neoadjuvant FOLFIRINOX for borderline resectable and locally advanced pancreatic cancer.