Thalji Sam Z, Kamgar Mandana, George Ben, Aldakkak Mohammed, Christians Kathleen K, Clarke Callisia N, Erickson Beth A, Hall William A, Tolat Parag P, Smith Zachary L, Evans Douglas B, Tsai Susan
Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Medicine, Division of Medical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann Surg Oncol. 2023 May;30(5):3013-3021. doi: 10.1245/s10434-022-13055-1. Epub 2023 Feb 14.
Response to second-line (2L) neoadjuvant therapy for operable pancreatic cancer (PC) is understudied. This study examined carbohydrate antigen 19-9 (CA19-9) response to first-line (1L) and 2L chemotherapy.
The study identified patients with operable PC and elevated CA19-9 (≥ 35 U/mL with total bilirubin < 2 mg/dL) who received 1L FOLFIRINOX (FFX). The patients were restaged after 2 months and based on response, received additional FFX or gemcitabine/nab-paclitaxel (GnP) as part of total neoadjuvant therapy. Response was defined as a decrease in tumor size on computed tomography (CT) imaging or a decline in CA19-9 of 50% or more and preserved performance status.
For operable PC with an elevated CA19-9, 108 patients received 1L FFX. After 2 months of chemotherapy, the decision was made to continue FFX (FFX ≥ FFX) for 76 (70%) of the 108 patients and switch to GnP (FFX ≥ GnP)) for 32 (30%) of the patients. Of the 32 FFX ≥ GnP patients, 27 had no evidence of radiographic or biochemical (CA19-9) response to 1L FFX. Of these 27 patients, 26 (96%) demonstrated a response to 2L GnP. After 4 months of chemotherapy, 62 (82%) of the 76 FFX ≥ FFX patients had a CA19-9 response compared with 31 (97%) of the 32 FFX ≥ GnP patients (p = 0.04).
Lack of biochemical response to 2 months of 1L FFX may identify a subgroup of patients with a very high rate of response to 2L GnP, emphasizing the importance of assessing treatment response at 2-month intervals.
可切除胰腺癌（PC）二线（2L）新辅助治疗的反应研究不足。本研究检测了碳水化合物抗原19-9（CA19-9）对一线（1L）和2L化疗的反应。
该研究纳入了可切除PC且CA19-9升高（≥35 U/mL且总胆红素<2 mg/dL）并接受1L FOLFIRINOX（FFX）治疗的患者。2个月后对患者进行重新分期，并根据反应情况，接受额外的FFX或吉西他滨/纳米白蛋白结合型紫杉醇（GnP）作为总新辅助治疗的一部分。反应定义为计算机断层扫描（CT）成像显示肿瘤大小减小或CA19-9下降50%或更多且保持体能状态。
对于CA19-9升高的可切除PC患者，108例接受了1L FFX治疗。化疗2个月后，108例患者中有76例（70%）决定继续使用FFX（FFX≥FFX组），32例（30%）患者改用GnP（FFX≥GnP组）。在32例FFX≥GnP组患者中，27例对1L FFX无影像学或生化（CA19-9）反应证据。在这27例患者中，26例（96%）对2L GnP有反应。化疗4个月后，76例FFX≥FFX组患者中有62例（82%）CA19-9有反应，而32例FFX≥GnP组患者中有31例（97%）有反应（p = 0.04）。
对1L FFX治疗2个月缺乏生化反应可能识别出一组对2L GnP反应率非常高的患者亚组，强调了每2个月评估治疗反应的重要性。
