TY - JOUR
T1 - Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer
T2 - A systematic review and patient-level meta-analysis
AU - Janssen, Quisette P.
AU - Buettner, Stefan
AU - Suker, Mustafa
AU - Beumer, Berend R.
AU - Addeo, Pietro
AU - Bachellier, Philippe
AU - Bahary, Nathan
AU - Bekaii-Saab, Tanios
AU - Bali, Maria A.
AU - Besselink, Marc G.
AU - Boone, Brian A.
AU - Chau, Ian
AU - Clarke, Stephen
AU - Dillhoff, Mary
AU - El-Rayes, Bassel F.
AU - Frakes, Jessica M.
AU - Grose, Derek
AU - Hosein, Peter J.
AU - Jamieson, Nigel B.
AU - Javed, Ammar A.
AU - Khan, Khurum
AU - Kim, Kyu Pyo
AU - Kim, Song Cheol
AU - Kim, Sunhee S.
AU - Ko, Andrew H.
AU - Lacy, Jill
AU - Margonis, Georgios A.
AU - McCarter, Martin D.
AU - McKay, Colin J.
AU - Mellon, Eric A.
AU - Moorcraft, Sing Yu
AU - Okada, Ken Ichi
AU - Paniccia, Alessandro
AU - Parikh, Parag J.
AU - Peters, Niek A.
AU - Rabl, Hans
AU - Samra, Jaswinder
AU - Tinchon, Christoph
AU - van Tienhoven, Geertjan
AU - van Veldhuisen, Eran
AU - Wang-Gillam, Andrea
AU - Weiss, Matthew J.
AU - Wilmink, Johanna W.
AU - Yamaue, Hiroki
AU - Homs, Marjolein Y.V.
AU - van Eijck, Casper H.J.
AU - Katz, Matthew H.G.
AU - Koerkamp, Bas Groot
N1 - Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - FOLFIRINOX is a standard treatment for metastatic pancreatic cancer patients. The effectiveness of neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer (BRPC) remains debated. Methods: We performed a systematic review and patient-level meta-analysis on neoadjuvant FOLFIRINOX in patients with BRPC. Studies with BRPC patients who received FOLFIRINOX as first-line neoadjuvant treatment were included. The primary endpoint was overall survival (OS), and secondary endpoints were progression-free survival, resection rate, R0 resection rate, and grade III-IV adverse events. Patient-level survival outcomes were obtained from authors of the included studies and analyzed using the Kaplan-Meier method. Results: We included 24 studies (8 prospective, 16 retrospective), comprising 313 (38.1%) BRPC patients treated with FOLFIRINOX. Most studies (n = 20) presented intention-to-treat results. The median number of administered neoadjuvant FOLFIRINOX cycles ranged from 4 to 9. The resection rate was 67.8% (95% confidence interval [CI] = 60.1% to 74.6%), and the R0-resection rate was 83.9% (95% CI = 76.8% to 89.1%). The median OS varied from 11.0 to 34.2 months across studies. Patient-level survival data were obtained for 20 studies representing 283 BRPC patients. The patient-level median OS was 22.2 months (95% CI = 18.8 to 25.6 months), and patient-level median progression-free survival was 18.0 months (95% CI = 14.5 to 21.5 months). Pooled event rates for grade III-IV adverse events were highest for neutropenia (17.5 per 100 patients, 95% CI = 10.3% to 28.3%), diarrhea (11.1 per 100 patients, 95% CI = 8.6 to 14.3), and fatigue (10.8 per 100 patients, 95% CI = 8.1 to 14.2). No deaths were attributed to FOLFIRINOX. Conclusions: This patient-level meta-analysis of BRPC patients treated with neoadjuvant FOLFIRINOX showed a favorable median OS, resection rate, and R0-resection rate. These results need to be assessed in a randomized trial.
AB - FOLFIRINOX is a standard treatment for metastatic pancreatic cancer patients. The effectiveness of neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer (BRPC) remains debated. Methods: We performed a systematic review and patient-level meta-analysis on neoadjuvant FOLFIRINOX in patients with BRPC. Studies with BRPC patients who received FOLFIRINOX as first-line neoadjuvant treatment were included. The primary endpoint was overall survival (OS), and secondary endpoints were progression-free survival, resection rate, R0 resection rate, and grade III-IV adverse events. Patient-level survival outcomes were obtained from authors of the included studies and analyzed using the Kaplan-Meier method. Results: We included 24 studies (8 prospective, 16 retrospective), comprising 313 (38.1%) BRPC patients treated with FOLFIRINOX. Most studies (n = 20) presented intention-to-treat results. The median number of administered neoadjuvant FOLFIRINOX cycles ranged from 4 to 9. The resection rate was 67.8% (95% confidence interval [CI] = 60.1% to 74.6%), and the R0-resection rate was 83.9% (95% CI = 76.8% to 89.1%). The median OS varied from 11.0 to 34.2 months across studies. Patient-level survival data were obtained for 20 studies representing 283 BRPC patients. The patient-level median OS was 22.2 months (95% CI = 18.8 to 25.6 months), and patient-level median progression-free survival was 18.0 months (95% CI = 14.5 to 21.5 months). Pooled event rates for grade III-IV adverse events were highest for neutropenia (17.5 per 100 patients, 95% CI = 10.3% to 28.3%), diarrhea (11.1 per 100 patients, 95% CI = 8.6 to 14.3), and fatigue (10.8 per 100 patients, 95% CI = 8.1 to 14.2). No deaths were attributed to FOLFIRINOX. Conclusions: This patient-level meta-analysis of BRPC patients treated with neoadjuvant FOLFIRINOX showed a favorable median OS, resection rate, and R0-resection rate. These results need to be assessed in a randomized trial.
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U2 - 10.1093/jnci/djz073
DO - 10.1093/jnci/djz073
M3 - Review article
C2 - 31086963
AN - SCOPUS:85072894072
SN - 0027-8874
VL - 111
SP - 782
EP - 794
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 8
ER -