Localized PDAC: which first-line therapy is best?

  • Perri G & al.
  • JAMA Surg
  • 15 Jul 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) may lead to more pancreatectomies than gemcitabine plus nab-paclitaxel in localized pancreatic ductal adenocarcinoma (PDAC).
  • Survival does not differ between the two.

Why this matters

  • FOLFIRINOX might be the best choice for patients with localized PDAC who have no contraindications and are deemed likely to tolerate the regimen’s toxicity profile.

Study design

  • Single-institution propensity-score-matched analysis (N=485).
  • Funding: NIH.

Key results

  • Patients in the FOLFIRINOX group were younger (median age, 61 vs 71 years; P=.001) and more frequently had Eastern Cooperative Oncology Group scale scores ≤2 (96% vs 82%; P=.001).
  • FOLFIRINOX recipients more often had invasive tumors (32% resectable vs 45% resectable; P=.01).
  • After propensity score matching, Response Evaluation Criteria in Solid Tumors partial response occurred more often in the FOLFIRINOX group (19% vs 6%; P=.001).
  • The FOLFIRINOX group more often underwent radiation/chemoradiation (53% vs 34%; P=.001) and was more likely to undergo pancreatectomy (27% vs 16%; P=.01).
  • There was no significant difference between the regimens in OS.

Limitations

  • The study needs to be confirmed prospectively.