1643P - Clinical outcomes of FOLFIRINOX as front-line therapy in patients with localized pancreatic adenocarcinoma: Asian retrospective study of 781 patients

Background

Neoadjuvant (m)FOLFIRINOX has been established as one of standard therapy for borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC). Recently, its use has been expanded to resectable pancreatic cancer (RPC), but large pragmatic studies, particularly in Asia, to show the implication of localized pancreatic adenocarcinoma are still lacking.

Methods

This retrospective study included 781 patients with localized pancreatic adenocarcinoma who received (m)FOLFIRINOX as initial therapy in Asan Medical Center, Seoul, Korea, between DEC 2017 and DEC 2020.

Results

The median age was 62 years, and 341 (43.8%) patients were female. According to the NCCN criteria, 131 (16.8%), 326 (41.9%), and 321 (41.3%) patients had RPC, BRPC and LAPC, respectively. The objective response rates were 22.1%, 16.3%, and 15.0%, respectively. The curative-intent resection (R0 or R1) was performed in 94 (71.8%) patients of the RPC group, 137 (42.0%) patients of the BRPC group, and 40 (12.5%) patients of the LAPC group; patients who underwent curative resection, the R0 resection rates were similar among three groups (86.2%, 86.1%, and 80.0%, respectively). There were 11 patients who achieved surgery following salvage chemotherapy after progression on initial (m)FOLFIRINOX. The median overall survival (OS) was 28.1 months (95% CI, 22.7–33.5) for RPC, 22.0 months (95% CI, 19.8–24.1) for BRPC, and 20.3 months (95% CI, 18.7–21.9) for LAPC (p<0.001). In each resectability group, median OS was significantly better in patients with surgical resection (RPC, 41.6 vs 14.5 months, p<0.001; BRPC, 37.3 vs 14.7, p<0.001; LAPC, 51.4 vs 18.5 months, p<0.001). In multivariate analysis, female gender, RPC, baseline CA 19-9 < median (118.7 U/mL), objective response (CR or PR), and curative-intent surgery were significantly associated with better OS.

Conclusions

This large retrospective cohort study provides the realistic key clinical outcome data such as resection rates, survival outcomes and prognostic factors in RPC, BRPC and LAPC treated with front-line (m)FOLFIRINOX.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.