Neoadjuvant modified (m) FOLFIRINOX for locally advanced unresectable (LAPC) and borderline resectable (BRPC) adenocarcinoma of the pancreas.
Neoadjuvant modified (m) FOLFIRINOX for locally advanced unresectable (LAPC) and borderline resectable (BRPC) adenocarcinoma of the pancreas.
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DOI：
10.1245/s10434-014-4225-1
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发表时间：
2015-04
影响因子：
3.7
通讯作者：
Bekaii-Saab T
中科院分区：
文献类型：
--
作者：
Blazer M;Wu C;Goldberg RM;Phillips G;Schmidt C;Muscarella P;Wuthrick E;Williams TM;Reardon J;Ellison EC;Bloomston M;Bekaii-Saab T
对于转移性胰腺癌患者，FOLFIRINOX(氟尿嘧啶[5-FU]、亚叶酸钙[LV]、伊立替康[IRI]和奥沙利铂)与吉西他滨相比存活率提高，但有显著的毒性，特别是在肿瘤负担较高的患者。由于报道的有效率超过30%，作者开始对晚期非转移性疾病患者使用改良的(M)FOLFIRINOX方案，目的是降低手术切除的分期。这份报告描述了他们使用mFOLFIRINOX和积极手术切除的经验。2011年1月至2013年8月，43例交界性可切除胰腺癌(BRPC，n=18)和局部晚期胰腺癌(LAPC，n=25)患者接受mFOLFIRINOX治疗(不给药，IRI减少)。根据反应和打算进行的手术进行放射治疗。在可能的情况下，回顾图表以评估反应、毒性和切除范围。最常见的3/4级毒性是6例(14%)患者腹泻，没有3/4级中性粒细胞减少或血小板减少。手术切除31例(72%)，成功22例(51.1%)，其中LAPC 11例(44%)。血管切除4例(18%)，其中R0切除占86.4%。发生并发症6例(27%)，无围手术期死亡。手术切除患者的中位无进展生存期为18个月，而未手术患者的中位无进展生存期为8个月(p<；0.001)。对于晚期非转移性胰腺癌患者，新辅助化疗方案mFOLFIRINOX是一种有效、耐受性良好的方案。当mFOLFIRINOX结合积极的手术时，即使最初的成像显示局部晚期疾病，高切除率也是可能的。尽管数据仍在不断完善，但切除术似乎至少提供了一种无进展的生存优势。
For patients with metastatic pancreatic cancer, FOLFIRINOX (fluorouracil [5-FU], leucovorin [LV], irinotecan [IRI], and oxaliplatin) has shown improved survival rates compared with gemcitabine but with significant toxicity, particularly in patients with a high tumor burden. Because of reported response rates exceeding 30 %, the authors began to use a modified (m) FOLFIRINOX regimen for patients with advanced nonmetastatic disease aimed at downstaging for resection. This report describes their experience with mFOLFIRINOX and aggressive surgical resection. Between January 2011 and August of 2013, 43 patients with borderline resectable pancreatic cancer (BRPC, n = 18) or locally advanced pancreatic cancer (LAPC, n = 25) were treated with mFOLFIRINOX (no bolus 5-FU, no LV, and decreased IRI). Radiation was used based on response and intended surgery. Charts were retrospectively reviewed to assess response, toxicities, and extent of resection when possible. The most common grade 3/4 toxicity was diarrhea in six patients (14 %) with no grade 3/4 neutropenia or thrombocytopenia. Resection was attempted in 31 cases (72 %) and accomplished in 22 cases (51.1 %) including 11 of 25 LAPC cases (44 %). Vascular resection was required in 4 cases (18 %), with R0 resection in 86.4 %of the resections. Complications occurred in 6 cases (27 %), with no perioperative deaths. The median progression-free survival period was 18 months if the resection was achieved compared with 8 months if no resection was performed (p < 0.001). Neoadjuvant mFOLFIRINOX is an effective, well-tolerated regimen for patients with advanced nonmetastatic pancreatic cancer. When mFOLFIRINOX is coupled with aggressive surgery, high resection rates are possible even when the initial imaging shows locally advanced disease. Although data are still maturing, resection appears to offer at least a progression-free survival advantage.
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影响因子：
45.3
作者：
Poplin, Elizabeth;Feng, Yang;Benson, Al Bowen, III
通讯作者：
Benson, Al Bowen, III
影响因子：
45.3
作者：
Moureau-Zabotto, Laurence;Phelip, Jean-Marc;Louvet, Christophe
通讯作者：
Louvet, Christophe
影响因子：
9
作者：
Kleeff, Joerg;Reiser, Carolin;Buechler, Markus W.
通讯作者：
Buechler, Markus W.
影响因子：
3.8
作者：
Hosein, Peter J.;Macintyre, Jessica;Rocha-Lima, Caio M.
通讯作者：
Rocha-Lima, Caio M.
影响因子：
2.7
作者：
Smeenk, HG;Incrocci, L;van Eijck, CHJ
通讯作者：
van Eijck, CHJ