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Antimetabolites

* Preoperative mFOLFIRINOX, every 2 weeks, 8 cycles
* Postoperative gemcitabine, every 4 weeks, 3-6 cycles

* Preoperative mFOLFIRINOX, every 2 weeks, 8 cycles

  * Oxaliplatin IV 85 mg/m2 Day (D) 1
  * Irinotecan IV 180 mg/m2 D1
  * 5-FU continuous IV infusion 2,400 mg/m2 over 46 hours D1-2
  * Leucovorin IV 400 mg/m2 D1
* Postoperative gemcitabine, every 4 weeks, 3-6 cycles - Gemcitabine 1,000 mg/ m2 D1, 8, and 15

Preoperative modified FOLFIRINOX and postoperative gemcitabine

Baek-Yeol Ryoo, MD, PhD

The purpose of this study is to assess the feasibility and efficacy outcomes of neoadjuvant modified FOLFIRINOX and postoperative gemcitabine in patients with borderline resectable pancreatic cancer.

Pancreatic cancer is the fourth leading cause of cancer-related death worldwide. The 5-year survival rate in overall patients is less than 6% due to late clinical manifestation and the systemic nature of the disease at presentation. Even in patients with resectable disease, estimated 5-year survival rates after resection are between 15% and 20%. Traditionally, resection alone is regarded as inadequate for cure. Therefore, systemic and/or combined chemotherapy and radiotherapy have been used as preoperative or postoperative therapy.

Neoadjuvant treatment offers several theoretical advantages over an initial resection. Early delivery of systemic therapy for all patients which might lead to the higher rates of negative margin resection rate, and enhanced patient selection for surgery. Although neoadjuvant treatment has been established as a standard of care for resectable or locally advanced disease of breast, gastric, and rectal cancers, the role of neoadjuvant treatment in patients with pancreatic cancer is not clear at present.

There is no global consensus on the management of patients with borderline resectable pancreatic cancer. If initially resected, postoperative adjuvant chemotherapy or chemoradiotherapy is standard. However, there is no standard regimen for neoadjuvant chemotherapy for pancreatic cancer. Recent pivotal phase 2/3 trial has demonstrated that FOLFIRINOX improved the response rates and survival outcomes of patients with metastatic pancreatic cancer compared to gemcitabine.

Because of higher response rates (about 30%) with FOLFIRINOX, this regimen is now widely investigated in the neoadjuvant setting. Therefore, investigators hypothesize that neoadjuvant FOLFIRINOX may enhance the outcomes of patients with borderline resectable pancreatic cancer. This study will assess the feasibility and efficacy outcomes of neoadjuvant modified FOLFIRINOX and postoperative gemcitabine in patients with borderline resectable pancreatic cancer.

Neoadjuvant Modified FOLFIRINOX in Borderline Resectable Pancreatic Cancer

Phase 2 Study of Neoadjuvant Modified FOLFIRINOX in Patients With Borderline Resectable Pancreas Adenocarcinoma

The rate of no gross residual disease after surgery

Response rate defined by Response Evaluation Criteria in Solid Tumor version 1.1

Adverse events graded by National Cancer Institute Common Terminology Criteria version 4.03

Blood-based biomarker analysis for the correlation with response rate, progression-free survival and overall survival

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Neoadjuvant Modified FOLFIRINOX in Borderline Resectable Pancreatic Cancer	NCT02749136	Pancreatic Aden...	Preoperative mo...	19 Years -	Asan Medical Center
Neoadjuvant Modified FOLFIRINOX in Borderline Resectable Pancreatic Cancer	NCT02749136	Pancreatic Aden...	Preoperative mo...	19 Years -	Asan Medical Center

Spots Global Cancer Trial Database for preoperative modified folfirinox and postoperative gemcitabine