Traitement néoadjuvant par folfirinox pour le cancer du pancréas borderline résécable et localement avancé

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State: Public
Version: After imprimatur
License: Not specified
Serval ID
serval:BIB_5D1D59591501
Type
A Master's thesis.
Publication sub-type
Master (thesis) (master)
Collection
Publications
Institution
Title
Traitement néoadjuvant par folfirinox pour le cancer du pancréas borderline résécable et localement avancé
Author(s)
GIROD F.
Director(s)
HALKIC N.
Codirector(s)
DIGKLIA A.
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Accepted
Issued date
2019
Language
french
Number of pages
29
Abstract
Introduction:
Pancreatic adenocarcinoma has a poor prognosis with a five-year survival
rate of 9% in 2018 (1). Surgery is the only hope for a cure but only 10% of
patients are diagnosed at a resectable stage (2). Neoadjuvant chemotherapy
folfirinox has been studied as a way to increase resection rate and improve
survival (3).
Objectif:
To evaluate the resection rate after neoadjuvant folfirinox for borderline
resectable and locally advanced pancreatic cancer and to identified prognosis
factors.
Methods:
We retrospectively reviewed patients treated with folfirinox in a neoadjuvant
setting for pancreatic cancer between 2013 and 2019 at a university hospital.
Results:
The resection rate after neoadjuvant folfirinox was 41% with 43% R0
resection. Median survival time (MST) was 26 months overall. MST was not
significantly longer in resected patients (19 months) as compared with nonresected
patients (29 months, P=0.25). There was a tendency towards better
MST for patients who received ≥ 6 cycles of neoadjuvant folfirinox (32
months) as compared to < 6 cycles (19 months, P=0.076). Median
progression free survival (PFS) was 13 months overall. Resected patients
and non-resected patients had similar PFS. Patients with platelet count > 300
x 109/L at diagnosis had a PFS significantly shorter than those with ≤ 300 x
109/L platelet (8 months and 14 months respectively, P=0.01). Leucocytes
count at diagnosis ≥ 8 x 109/L significantly reduced PFS as compared to
leucocytes count < 8 x 109/L (11 months and 14 months respectively,
P=0.04). Furthermore, ≥ 6 cycles of neoadjuvant chemotherapy allowed
patients to survived without progression longer than those with < 6 cycles (8
months versus 14 months, P=0.005). Cox’s proportional hazards regression
univariate analysis showed that platelet count > 300 x 109/L (hazard ratio HR
6.35, P=0.03), leucocytes count ≥ 8 x 109/L (HR 3.3, P=0.06) and < 6 cycles
of neoadjuvant chemotherapy were significantly associated with poor
progression-free survival (HR 4.72, P=0.01). By multivariable analysis, only <
6 cycles of neoadjuvant chemotherapy were independently associated with
poor progression-free survival (HR 6.74, P=0.02).
Conclusion :
In this retrospective analysis, resection rate after neoadjuvant treatment was
41%. High platelet count, high leucocytes count and < 6 cycles of
neoadjuvant treatment seemed to be associated with poor progression-free
survival.
Keywords
pancreatic cancer, borderline resectable, locally advanced, neoadjuvant, folfirinox
Create date
03/09/2020 14:17
Last modification date
09/10/2020 5:26
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