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Pathologic Major Response After FOLFIRINOX is Prognostic for Patients Secondary Resected for Borderline or Locally Advanced Pancreatic Adenocarcinoma: An AGEO-FRENCH, Prospective, Multicentric Cohort

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Abstract

Purpose

In view of increased response rates and survivals in patients with metastatic pancreatic adenocarcinoma (PAC) with FOLFIRINOX, many centers proposed this regimen as induction chemotherapy for borderline (BR) or locally advanced (LA) PAC. The aim of this study was to assess surgical and oncological outcomes of patients who underwent resection after induction FOLFIRINOX therapy.

Methods

We prospectively identified surgical consecutive BR or LA PAC patients after induction FOLFIRINOX in 20 observational French centers between November 2010 and December 2013. Two independent experts retrospectively evaluated initial CT scan for central review.

Results

Eighty patients were included, 47 had BR and 33 had LA PAC. Median number of FOLFIRINOX cycles was 6 (range 1–30) and 65 % of patients received chemoradiation. The 30-day-mortality, major complications, and symptomatic pancreatic fistula rates were 2.5, 22.5, and 4 %, respectively. R0 resection was achieved in 84 %. After a median follow-up of 38.2 months since diagnosis, disease-free survival (DFS) was 17.16 months. The overall survival rates at 12 and 24 months were 92 and 81 %, respectively. A 26 % (n = 21) pathologic major response (pMR) rate was reached. In univariate and multivariate analysis, pMR was a prognostic factor for DFS (hazard ratio 0.33; P = 0.01 and hazard ratio 0.38; P = 0.035).

Conclusions

Resection after induction FOLFIRINOX is safe and associated with similar or better outcomes as upfront surgery in patients with PAC. A pMR was observed in 26 % of cases and was prognostic of DFS. This therapeutic design should be investigated in prospective studies.

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Acknowledgements

Daniel Pietrasz and Jean Baptiste Bachet had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The authors thank Magdalena Benetkiewicz for reviewing the English form of this manuscript. This study was supported by a grant from Celgene, and by the AGEO and FRENCH associations.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Jean Baptiste Bachet MD, PhD.

Additional information

Antonio Sa Cunha and Jean Baptiste Bachet have contributed equally to this work.

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Appendix: Clinical Investigators Who Collected Data, Provided, and Cared for Study Patients

Appendix: Clinical Investigators Who Collected Data, Provided, and Cared for Study Patients

Thomas Aparicio, MD (Avicenne Hospital, Bobigny, France).

Pascal Artru, MD (Jean Mermoz Hospital, Lyon, France).

Anne Berger, MD (Georges Pompidou European Hospital, Paris, France).

Laurence Chiche, MD (Bordeaux South Hospital, Bordeaux, France).

Jean-Robert Delpero, MD (Institut Paoli Calmette, Marseille, France).

Bertrand Dousset, MD (Cochin Hospital, Paris, France).

Eric Francois, MD (Nice Hospital, Nice, France).

Diane Goéré, MD (Gustave Roussy, Villejuif, France).

Pascal Hammel, MD (Beaujon Hospital, Clichy, France).

Mehdi Karoui, MD (Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France).

Cédric Lecaille, MD (Bordeaux North Hospital, Bordeaux, France).

David Malka, MD (Gustave Roussy, Villejuif, France).

Sylvain Mandredi, MD (Rennes Hospital, Rennes, France).

Florence Mary, MD (Bordeaux Saint-André Hospital, Bordeaux, France).

Bernard Meunier, MD (Rennes Hospital, Rennes, France).

François Paye, MD (Saint-Antoine Hospital, Paris, France).

Anne Laure Pointet, MD (Georges Pompidou European Hospital, Paris, France).

Alain Sauvanet, MD (Beaujon Hospital, Clichy, France).

Lilian Schwarz, MD (Rouen Hospital, Rouen, France).

Jean-Marc Simon, MD (Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France).

Denis Smith, MD (Bordeaux Saint André Hospital, Bordeaux, France).

Emilie Soularue, MD (Georges Pompidou European Hospital, Paris, France).

Jean-Christophe Vaillant, MD (Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France).

Véronique Vendrely, MD (Bordeaux Haut-Lévêque Hospital, Bordeaux, France).

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Pietrasz, D., Marthey, L., Wagner, M. et al. Pathologic Major Response After FOLFIRINOX is Prognostic for Patients Secondary Resected for Borderline or Locally Advanced Pancreatic Adenocarcinoma: An AGEO-FRENCH, Prospective, Multicentric Cohort. Ann Surg Oncol 22 (Suppl 3), 1196–1205 (2015). https://doi.org/10.1245/s10434-015-4783-x

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