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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2020

01-10-2020 | Pancreatic Cancer | Pancreatic Tumors

Increased Rate of Complete Pathologic Response After Neoadjuvant FOLFIRINOX for BRCA Mutation Carriers with Borderline Resectable Pancreatic Cancer

Authors: Talia Golan, MD, Alex Barenboim, MD, Guy Lahat, MD, Ido Nachmany, MD, Yacov Goykhman, MD, Einat Shacham-Shmueli, MD, Naama Halpern, MD, Eli Brazowski, MD, Ravit Geva, MD, Ido Wolf, MD, Yuri Goldes, MD, Menahem Ben-Haim, MD, Joseph M. Klausner, MD, Nir Lubezky, MD

Published in: Annals of Surgical Oncology | Issue 10/2020

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Abstract

Background

Neoadjuvant FOLFIRINOX is a standard-of-care treatment for BRPC patients. Patients with gBRCAm who have demonstrated improved response to platinum-based chemotherapy may have impaired homologous repair deficiency. This study aimed to describe the pathologic complete response rate and long-term survival for patients with germline BRCA1 or BRCA2 mutation (gBRCAm) and borderline resectable pancreatic cancer (BRPC) treated with neoadjuvant FOLFIRINOX.

Methods

A dual-center retrospective analysis was performed. Patients who had BRPC treated with neoadjuvant FOLFIRINOX followed by curative resection were identified from clinical databases. Pathologic complete response was defined as no viable tumor cells present in the specimen. Common founder Jewish germline BRCA1 or BRCA2 mutation was determined for available patients.

Results

The 61 BRPC patients in this study underwent resection after neoadjuvant FOLFIRINOX. Analysis of BRCA mutation was performed for 39 patients, and 9 patients were found to be BRCA2 germline mutation carriers. The pathologic complete response rate was 44.4% for the gBRCAm patients and 10% for the BRCA non-carriers (p = 0.009). The median disease-free survival was not reached for the gBRCAm patients and was 7 months for the BRCA non-carriers (p = 0.03). The median overall survival was not reached for the gBRCAm patients and was 32 months for the BRCA non-carriers (p = 0.2). After a mean follow-up period of 33.7 months, all eight patients with pathologic complete response were disease-free.

Conclusions

The study showed that gBRCAm patients with BRPC have an increased chance for pathologic complete response and prolonged survival after neoadjuvant FOLFIRINOX. The results support the benefit of exposing gBRCAm patients to platinum-based chemotherapy early in the course of the disease. Neoadjuvant FOLFIRINOX should be considered for BRCA carriers who have resectable pancreatic cancer.
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Metadata
Title
Increased Rate of Complete Pathologic Response After Neoadjuvant FOLFIRINOX for BRCA Mutation Carriers with Borderline Resectable Pancreatic Cancer
Authors
Talia Golan, MD
Alex Barenboim, MD
Guy Lahat, MD
Ido Nachmany, MD
Yacov Goykhman, MD
Einat Shacham-Shmueli, MD
Naama Halpern, MD
Eli Brazowski, MD
Ravit Geva, MD
Ido Wolf, MD
Yuri Goldes, MD
Menahem Ben-Haim, MD
Joseph M. Klausner, MD
Nir Lubezky, MD
Publication date
01-10-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08469-8

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