Neoadjuvant FOLFIRINOX in Patients With Borderline Resectable Pancreatic Cancer: A Systematic Review and Patient-Level Meta-Analysis.
In: Journal of the National Cancer Institute, Jg. 111 (2019-08-01), Heft 8, S. 782-794
Online
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Zugriff:
Background: 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.
(© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
| Titel: |
Neoadjuvant FOLFIRINOX in Patients With Borderline Resectable Pancreatic Cancer: A Systematic Review and Patient-Level Meta-Analysis.
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| Autor/in / Beteiligte Person: | Janssen, QP ; Buettner, S ; Suker, M ; Beumer, BR ; Addeo, P ; Bachellier, P ; Bahary, N ; Bekaii-Saab, T ; Bali, MA ; Besselink, MG ; Boone, BA ; Chau, I ; Clarke, S ; Dillhoff, M ; El-Rayes, BF ; Frakes, JM ; Grose, D ; Hosein, PJ ; Jamieson, NB ; Javed, AA ; Khan, K ; Kim, KP ; Kim, SC ; Kim, SS ; Ko, AH ; Lacy, J ; Margonis, GA ; McCarter, MD ; McKay, CJ ; Mellon, EA ; Moorcraft, SY ; Okada, KI ; Paniccia, A ; Parikh, PJ ; Peters, NA ; Rabl, H ; Samra, J ; Tinchon, C ; van Tienhoven G ; van Veldhuisen E ; Wang-Gillam, A ; Weiss, MJ ; Wilmink, JW ; Yamaue, H ; Homs, MYV ; van Eijck CHJ ; Katz, MHG ; Groot Koerkamp, B |
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| Zeitschrift: | Journal of the National Cancer Institute, Jg. 111 (2019-08-01), Heft 8, S. 782-794 |
| Veröffentlichung: | <2003-> : Cary, NC : Oxford University Press ; <i>Original Publication</i>: Bethesda, Md., U. S. Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health; Washington, for sale by the Supt. of Docs., U. S. Govt. Print. Off., 2019 |
| Medientyp: | academicJournal |
| ISSN: | 1460-2105 (electronic) |
| DOI: | 10.1093/jnci/djz073 |
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