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Clinical Study

Role of FOLFIRINOX and chemoradiotherapy in locally advanced and borderline resectable pancreatic adenocarcinoma: update of the AGEO cohort

British Journal of Cancer volume 124, pages 1941–1948 (2021)Cite this article

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Abstract

Background

FOLFIRINOX has shown promising results in locally advanced (LAPA) or borderline resectable (BRPA) pancreatic adenocarcinoma. We report here a cohort of patients treated with this regimen from the AGEO group.

Methods

This is a retrospective multicentre study. We included all consecutive patients with non-pre-treated LAPA or BRPA treated with FOLFIRINOX.

Results

We included 330 patients (57.9% male, 65.4% <65 years, 96.4% PS <2). Disease was classified as BRPA in 31.1% or LAPA in 68.9%. Objective response rate with FOLFIRINOX was 29.5% and stable disease 51%. Subsequent CRT was performed in 46.4% of patients and 23.9% had curative intent surgery. Resection rates were 42.1% for BRPA and 15.5% for LAPA. Main G3/4 toxicities were fatigue (15%), neutropenia (12%) and neuropathy (G2/3 35%). After a median follow-up of 26.7 months, median OS (mOS) and PFS were 21.4 and 12.4 months, respectively. For patients treated by FOLFIRINOX alone, or FOLFIRINOX followed by CRT, or FOLFIRINOX + /− CRT + surgery, mOS was 16.8 months, 21.8 months and not reached, respectively (p < 0.0001).

Conclusions

FOLFIRINOX for LAPA and BRPA seems to be effective with a manageable toxicity profile. These promising results in “real-life” patients now have to be confirmed in a Phase 3 randomised trial.

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Fig. 1: Study flowchart showing the treatments according to BRPA and LAPA populations.
Fig. 2: Survival curves in the overall study population.

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Acknowledgements

The authors would like to acknowledge David Marsh (language review).

Author information

Authors and Affiliations

  1. Department of Hepato-Gastroenterology and Gastrointestinal Oncology, Université de Paris, Paris Descartes University, Hôpital Européen Georges Pompidou, Paris, France

    Edouard Auclin & Julien Taieb

  2. Department of Medical and Thoracic Oncology, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France

    Edouard Auclin

  3. Department of Gastroenterology, Kremlin Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Sud University, Le Kremlin Bicêtre, France

    Lysiane Marthey & Raef Abdallah

  4. Department of Gastroenterology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Léo Mas & Jean-Baptiste Bachet

  5. Department of Oncology, Anticancer Center A Lacassagne, Nice, France

    Eric Francois & Angélique Saint

  6. Department of Digestive Surgery, Hôpital Paul Brousse, Villejuif, France

    Antonio Sa Cunha

  7. Department of Oncology, Besançon University Hospital, Besançon, France

    Angélique Vienot

  8. Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Trousseau, Tours, France

    Thierry Lecomte

  9. Department of Gastroenterology and Digestive Oncology, Amiens University Hospital, Amiens, France

    Vincent Hautefeuille

  10. Department of Gastrointestinal Oncology, Centre Léon Bérard, Lyon, France

    Christelle de La Fouchardière & Matthieu Sarabi

  11. Department of Oncology, Institute Salah-Azaïz, Tunis, Tunisia

    Feryel Ksontini

  12. Department of Gastroenterology, Hôpital Edouard Herriot, Lyon, France

    Julien Forestier

  13. Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Romain Coriat

  14. Department of Radiotherapy, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France

    Emmanuelle Fabiano

  15. Department of GI Oncology, Institut Gustave Roussy, Villejuif, France

    Florence Leroy

  16. Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France

    Nicolas Williet

  17. Department of Hepato-Gastroenterology, Poitiers University Hospital, University of Poitiers, Poitiers, France

    David Tougeron

Authors
  1. Edouard Auclin
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Contributions

E.A.: study design, statistical analysis, manuscript writing and editing. L. Marthey: study design, data collection, manuscript writing, R.A., L. Mas, E. Francois, A.S., A.S.C., A.V., T.L., V.H., C.d.L.F., M.S., F.K., J.F., R.C., E. Fabiano, F.L., N.W.: data collection, manuscript writing, J.B.B., D.T.: study design, manuscript writing, J.T.: study design, data analysis, manuscript writing.

Corresponding author

Correspondence to Julien Taieb.

Ethics declarations

Ethics approval and consent to participate

No informed consent was needed for this observational study, as stated by the French ethics committee consulted prior to the beginning of the work.

Data availability

Data are available from J.T. at reasonable request.

Competing interests

E.A.: Travel expenses: Mundipharma. Lectures and educational activities: Sanofi Genzymes, Lilly-Oncology. J.T.: Consulting or advisory role: Roche, Merck KGaA, Darmstadt, Germany, Amgen, Celgene, Eli Lilly, Servier, Sirtex Medical, Merck Sharp & Dohme, Pierre Fabre. Speakers’ Bureau: Servier, Amgen, Roche/Genentech, Sanofi, Merck KGaA, Darmstadt, Germany, Eli Lilly, Merck Sharp & Dohme, Pierre Fabre. The other authors have nothing to declare.

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Auclin, E., Marthey, L., Abdallah, R. et al. Role of FOLFIRINOX and chemoradiotherapy in locally advanced and borderline resectable pancreatic adenocarcinoma: update of the AGEO cohort. Br J Cancer 124, 1941–1948 (2021). https://doi.org/10.1038/s41416-021-01341-w

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