Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer: a systematic review and patient-level meta-analysis
A partir d'une revue systématique de la littérature (24 études, 313 patients), cette méta-analyse évalue l'efficacité, du point de vue de la survie globale, et la toxicité d'une chimiothérapie néoadjuvante de type FOLFORINOX chez des patients atteints d'un cancer du pancréas à la limite de la résécabilité
Background : FOLFIRINOX is a standard treatment for metastatic pancreatic cancer patients. The effectiveness of neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer (BRPC) remains debated. Methods : We performed a systematic review and patient-level meta-analysis on neoadjuvant FOLFIRINOX in patients with BRPC. Studies with BRPC patients who received FOLFIRINOX as first-line neoadjuvant treatment were included. Primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), resection rate, R0-resection rate, and grade 3-4 adverse events. Patient-level survival outcomes were obtained from authors of the included studies and analyzed using the Kaplan-Meier method. Results : We included 24 studies (8 prospective, 16 retrospective), comprising 313 (38.1%) BRPC patients treated with FOLFIRINOX. Most studies (n=20) presented intention-to-treat results. The median number of administered neoadjuvant FOLFIRINOX cycles ranged from 4 to 9. The resection rate was 67.8% (95% CI: 60.1 – 74.6), the R0-resection rate was 83.9% (95% CI: 76.8 – 89.1). The median OS varied from 11.0 to 34.2 months across studies. Patient-level survival data was obtained for 20 studies representing 283 BRPC patients. Patient-level median OS was 22.2 months (95% CI: 18.8 – 25.6), patient-level median PFS was 18.0 months (95% CI: 14.5 – 21.5). Pooled event rates for grade 3-4 adverse events were highest for neutropenia (17.5 per 100 patients, 95% CI: 10.3 – 28.3), diarrhea (11.1 per 100 patients, 95% CI: 8.6 – 14.3), and fatigue (10.8 per 100 patients, 95% CI 8.1 – 14.2). No deaths were attributed to FOLFIRINOX. Conclusion : This patient-level meta-analysis of BRPC patients treated with neoadjuvant FOLFIRINOX showed a favorable median OS, resection rate, and R0-resection rate. These results need to be assessed in a randomized trial.