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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2024

22-11-2023 | Cytostatic Therapy | Pancreatic Tumors

In Neoadjuvant FOLFIRINOX Chemotherapy for Pancreatic Ductal Adenocarcinoma, Which Response is the More Reliable Indicator for Prognosis, Radiologic or Biochemical?

Authors: Won-Gun Yun, MD, Youngmin Han, PhD, Young Jae Cho, MD, Hye-Sol Jung, MD, Mirang Lee, MD, Wooil Kwon, MD, PhD, Jin-Young Jang, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2024

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Abstract

Background

In this era of increasing neoadjuvant chemotherapy, methods for evaluating responses to neoadjuvant chemotherapy are still diverse among institutions. Additionally, the efficacy of adjuvant chemotherapy for patients undergoing neoadjuvant chemotherapy remains unclear. Therefore, this retrospective study was performed to evaluate the effectiveness of methods for assessing response to neoadjuvant chemotherapy and the need for adjuvant chemotherapy in treating patients with non-metastatic pancreatic ductal adenocarcinoma.

Methods

The study identified 150 patients who underwent neoadjuvant FOLFIRINOX chemotherapy followed by curative-intent pancreatectomy. The patients were stratified by biochemical response based on the normalization of carbohydrate antigen 19-9 and by radiologic response based on size change at imaging.

Results

The patients were classified into the following three groups based on their response to neoadjuvant chemotherapy and prognosis: biochemical responders (BR+), radiology-only responders (BR–/RR+), and non-responders (BR–/RR–). The 3-year overall survival rate was higher for BR+ (71.0%) than for BR–/RR+ (53.6%) or BR–/RR– (33.1%) (P < 0.001). Response to neoadjuvant chemotherapy also was identified as a significant risk factor for recurrence in a comparison between BR–/RR+ and BR+ (hazard ratio [HR], 2.15; 95% confidence interval [CI] 1.19–3.88; P = 0.011) and BR–/RR– (HR, 3.82; 95% CI 2.41–6.08; P < 0.001). Additionally, regardless of the response to neoadjuvant chemotherapy, patients who completed adjuvant chemotherapy had a significantly higher 3-year overall survival rate than those who did not.

Conclusions

This response evaluation criterion for neoadjuvant chemotherapy is feasible and can significantly predict prognosis. Additionally, completion of adjuvant chemotherapy could be helpful to patients who undergo neoadjuvant chemotherapy regardless of their response to neoadjuvant chemotherapy.
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Metadata
Title
In Neoadjuvant FOLFIRINOX Chemotherapy for Pancreatic Ductal Adenocarcinoma, Which Response is the More Reliable Indicator for Prognosis, Radiologic or Biochemical?
Authors
Won-Gun Yun, MD
Youngmin Han, PhD
Young Jae Cho, MD
Hye-Sol Jung, MD
Mirang Lee, MD
Wooil Kwon, MD, PhD
Jin-Young Jang, MD, PhD
Publication date
22-11-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14532-x

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