Patients with borderline resectable pancreatic cancer (PDAC) are often treated with chemotherapy, radiotherapy, or both before undergoing surgery, but the optimal regimen in this setting is controversial.
New results suggest that the reference regimen should be neoadjuvant therapy with modified FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 400 mg/m2, and infusional 5-fluorouracil 2400 mg/m2 over 46 hours).
This regimen improved survival for patients with PDAC relative to historical data, say researachers who presented results from the Alliance A021501 study.
For patients who received mFOLFIRINOX, the overall 18-month survival rate was 66.4%. However, when this regimen was combined with hypofractionated radiotherapy, the survival benefit was significantly lower, at 47.3%.
The findings were presented at the Gastrointestinal Cancers Symposium (GICS) 2021, which was held online this year.
"ASCO guidelines recommend that preoperative therapy be administered to patients with localized pancreatic adenocarcinoma who have tumors that have a significant radiographic interface with the major mesenteric blood vessels, as these patients are at high risk for a margin-positive operation and short survival when pancreatectomy is performed de novo," explained study author Matthew Katz, MD, FACS, chief of the Pancreatic Surgery Service at the University of Texas MD Anderson Cancer Center, Houston, Texas.
Although both chemotherapy and radiotherapy are used in these patients, there is no consensus as to the best approach, he commented.
