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Study: FOLFIRINOX Followed by Chemoradiation Shows Substantial Activity in Locally Advanced Pancreatic Cancer
Date:5/8/2013

median of 2.5 full-dose cycles. The median follow-up was 19.3 months. The overall response rate was 27.3% while on FOLFIRINOX and 36.4% after chemoradiation. Following neoadjuvant FOLFIRINOX and chemoradiation, 5 of 22 patients (23%) were able to undergo R0 resections. Of these, however, 3 patients experienced distant recurrence at a median of 81 days after surgery. The median progression-free survival for all patients was 11.7 months.

“We believe the results are promising for this strategy, in a group of patients where the historical possibility for resection is low and the overall prognosis quite dismal,” Dr. Faris said. “However, this promise must be evaluated against the recurrences observed in the patients who were able to undergo resection, as well as the toxicity signal that is present with this multidrug regimen. Prospective evaluation of therapies for patients with locally advanced pancreatic cancer will be critical to improving treatments and outcomes for this group of patients."

The risk of toxicity was high, with 7 patients (32%) requiring at least one emergency department visit or hospitalization during treatment with FOLFIRINOX. Two patients discontinued FOLFIRINOX for treatment-related toxicity.

These findings raise the question of whether a patient with initially unresectable pancreatic cancer who achieves an R0 resection after neoadjuvant FOLFIRINOX is really curable, the study authors said, given the high rate of distant recurrence after surgery. Alternatively, palliative systemic chemotherapy and/or chemoradiation may allow patients to achieve the same outcome, while avoiding the known morbidity and potential mortality of surgical resection.

Researchers will continue to explore the utility of FOLFIRINOX at the Massachusetts General Hospital Cancer Center, where separate treatment protocols are in use for patients with clearly resectable disease, borderline resectable disease, and locally advanced pancreatic ca
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