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FOLFIRINOX Should Remain Adjuvant Standard for Resectable Pancreatic Cancer

Brandon Scalea
Published: Tuesday, Feb 26, 2019

Matthew H.G. Katz, MD, FACS

Matthew H.G. Katz, MD, FACS

Systemic chemotherapy with FOLFIRINOX should be the backbone of treatment for patients with localized pancreatic cancer who have undergone surgical resection, said Matthew H.G. Katz, MD, FACS.

State of the Science Summit™ on Gastrointestinal Cancers, Katz highlighted pivotal trials in pancreatic cancer and how these data are shifting the treatment paradigm for these patients.

OncLive: Could you discuss the key takeaways from the PRODIGE 24/CCTG PA.6 trial?

Katz: This was a very important study that randomized patients undergoing surgical resection for their cancer to either systemic chemotherapy with gemcitabine or systemic chemotherapy with mFOLFIRINOX. This is an important trial because the patients who received mFOLFIRINOX had the longest median OS that has been ever reported. Median OS was more than 50 months—significantly longer than patients who received gemcitabine, which was only about 35 months. Therefore, chemotherapy with mFOLFIRINOX is the standard of care for patients who undergo surgical resection for pancreatic cancer, as long as they can tolerate that therapy.

I would say that FOLFIRINOX is now the backbone of therapy for patients who have undergone surgical resection. You can add any experimental agent that you can imagine to that.

Could you discuss the PREOPANC-1 study? What were the clinical implications of its findings?

This was a European study which looked at patients with resectable pancreatic cancer or borderline resectable disease. About half of those patients had more advanced cancers. It was essentially a study of 1 preoperative regimen: gemcitabine-based chemoradiation. Patients who were enrolled in this trial—and they had to have decent performance status—were randomized [to undergo either immediate surgery or preoperative chemoradiation, both followed by adjuvant chemotherapy]. That study showed that patients who were enrolled in the preoperative chemoradiation arm lived longer than those who underwent surgery first. This was one of the first studies to show a significant benefit to the addition of preoperative chemoradiation therapy [in these patients].

What are the drawbacks to preoperative chemoradiation?

For patients with localized cancer, we know that surgery is beneficial as long as the patient is healthy and can tolerate the operation. We know that for those who receive surgery, postoperative chemotherapy improves survival compared with surgery alone. What we do not completely understand is the role of radiation therapy. I believe there is some role to giving radiation, either preoperatively or postoperatively.
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