Yoo Changhoon, Kang Jihoon, Kim Kyu-Pyo, Lee Jae-Lyun, Ryoo Baek-Yeol, Chang Heung-Moon, Lee Sang Soo, Park Do Hyun, Song Tae Jun, Seo Dong Wan, Lee Sung Koo, Kim Myung-Hwan, Park Jin-Hong, Hwang Dae Wook, Song Ki Byung, Lee Jae Hoon, Kim Song Cheol
Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Departments of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Oncotarget. 2017 Jul 11;8(28):46337-46347. doi: 10.18632/oncotarget.17940.
Borderline resectable pancreatic cancer (BRPC) is a potentially resectable disease but is associated with poorer survival compared to primary resectable disease. There has been no prospective trial that compare the efficacy of FOLFIRNOX and gemcitabine-based regimen for BRPC. Between February 2013 and December 2014, 18 patients with BRPC receiving FOLFIRINOX were reviewed retrospectively. For comparative analysis, data for all BRPC patients (n=18) in our previous phase 2 study of neoadjuvant fixed-dose rate-gemcitabine plus capecitabine were pooled. Patients received a median 6 cycles (range, 3-13) of FOLFIRINOX. Surgical resection was performed in 12 patients (67%) and R0 resection in 9 patients. Median progression-free survival (PFS) and overall survival (OS) were 16.8 (95% confidence interval [CI], 9.4-24.2) and 21.2 (95% CI, 14.2-28.2) months, respectively. Patients who underwent surgical resection showed significantly better PFS (p=0.01) and OS (p=0.003) than those unresected. In the exploratory analysis, patients receiving FOLFIRINOX showed significantly longer PFS compared to those receiving fixed-dose rate-gemcitabine plus capecitabine (median 16.8 months [95% CI, 9.4-24.2] vs. 6.5 months [1.6-11.3]; p = 0.04). There was a trend toward improved OS in patients who received FOLFIRINOX (median 21.2 months [95% CI, 14.2-28.2]) compared to those who received fixed-dose rate-gemcitabine plus capecitabine (13.6 months [11.8-15.4]; p=0.12). FOLFIRINOX was feasible and effective as neoadjuvant chemotherapy for patients with BRPC and may have improved efficacy compared to a gemcitabine-based regimen.
可切除边缘的胰腺癌（BRPC）是一种潜在可切除的疾病，但与原发性可切除疾病相比，其生存率较低。目前尚无前瞻性试验比较FOLFIRNOX和基于吉西他滨的方案对BRPC的疗效。回顾性分析了2013年2月至2014年12月期间18例接受FOLFIRINOX治疗的BRPC患者。为进行对比分析，汇总了我们之前关于新辅助固定剂量率吉西他滨联合卡培他滨的2期研究中所有BRPC患者（n = 18）的数据。患者接受FOLFIRINOX的中位周期数为6个周期（范围3 - 13个周期）。12例患者（67%）接受了手术切除，9例患者实现了R0切除。中位无进展生存期（PFS）和总生存期（OS）分别为16.8个月（95%置信区间[CI]，9.4 - 24.2）和21.2个月（95% CI，14.2 - 28.2）。接受手术切除的患者的PFS（p = 0.01）和OS（p = 0.003）显著优于未接受手术切除的患者。在探索性分析中，接受FOLFIRINOX治疗的患者的PFS显著长于接受固定剂量率吉西他滨联合卡培他滨治疗的患者（中位16.8个月[95% CI，9.4 - 24.2] vs. 6.5个月[1.6 - 11.3]；p = 0.04）。与接受固定剂量率吉西他滨联合卡培他滨治疗的患者（13.6个月[11.8 - 15.4]；p = 0.12）相比，接受FOLFIRINOX治疗的患者的OS有改善趋势（中位21.2个月[95% CI，14.2 - 28.2]）。FOLFIRINOX作为BRPC患者的新辅助化疗是可行且有效的，与基于吉西他滨的方案相比可能具有更好的疗效。
