Perioperative Chemo Enhances Pancreatic Cancer Progression-Free Survival

For individuals diagnosed with resectable pancreatic ductal adenocarcinoma (PDAC), the 12-month progression-free survival (PFS) rate might be improved with a neoadjuvant regimen of modified 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan (mFOLFIRINOX). This finding comes from a study published online June 20 in JAMA Oncology.

Dr. Michael Cecchini from Yale University School of Medicine, along with his colleagues, conducted an open-label phase 2 clinical trial to investigate whether administering mFOLFIRINOX prior to surgery could lead to early control of micrometastasis and enhance survival rates in patients with resectable PDAC. The study involved 46 patients who received six cycles of neoadjuvant mFOLFIRINOX before undergoing surgical procedures, followed by an additional six cycles of adjuvant mFOLFIRINOX post-surgery.

The study results indicated that out of the 46 patients, 37 completed all six cycles of preoperative mFOLFIRINOX, and 33 patients proceeded to surgery. Of these, 27 individuals underwent surgical resection as per the study protocol. During the surgical exploration, six patients were found to have either metastatic or unresectable disease, and another 10 patients had to undergo surgery outside the study protocol. The 12-month PFS rate for these patients was observed to be 67%, with a median PFS of 16.6 months and a median overall survival (OS) of 37.2 months.

Additionally, the researchers monitored baseline circulating tumor DNA (ctDNA) levels in 16 out of 22 patients. After six cycles of mFOLFIRINOX, only three out of 17 patients (18%) had detectable ctDNA levels. Patients with detectable ctDNA levels four weeks after resection exhibited worse PFS and OS compared to those with undetectable ctDNA levels.

Despite these promising survival rates, Dr. Cecchini and his team emphasized the necessity of conducting a randomized clinical trial to definitively determine whether perioperative mFOLFIRINOX offers a significant advantage over the traditional adjuvant FOLFIRINOX regimen in enhancing cure rates.

Several authors involved in this study disclosed affiliations with the pharmaceutical and biotechnology industries, underscoring the potential influence of industry ties on research findings. The study has garnered attention in the medical community and highlights the ongoing efforts to improve treatment outcomes for patients with resectable PDAC through innovative therapeutic approaches.