Should All Patients With Pancreatic Cancer Receive Chemotherapy Before Surgery?
Menée à partir de données portant sur 485 patients atteints d'un adénocarcinome canalaire pancréatique, cette étude de cohorte compare l'efficacité, du point de vue du taux de réponse, du taux de résection et de la survie globale, d'une chimiothérapie de première ligne de type FOLFIRINOX et d'une chimiothérapie combinant gemcitabine et nab-paclitaxel (durée médiane de suivi : 33 mois)
During the last decade, moderate progress in the treatment of pancreatic ductal adenocarcinoma (PDAC) has been realized with updated chemotherapeutic regimens, advanced operative techniques, and in some cases, targeted genetic-based therapy. Treating patients with borderline resectable or locally advanced tumors using neoadjuvant chemotherapy may provide benefit. Current treatment regimens have extrapolated from the success of FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin) and gemcitabine plus nab-paclitaxel (GA) in the setting of metastatic PDAC.In this issue of JAMA Surgery, Perri et al report the results of a single-institution, case series study of 485 patients with localized PDAC who received neoadjuvant FOLFIRINOX or GA. The strength of this study is the use of propensity matching because patients in the FOLFIRINOX group overall were younger, had better performance status, received fewer cycles of chemotherapy, and had more invasive tumors. After matching, many metrics of response did not differ between the treatment groups, such as primary tumor volume, tumor downstaging, or serum cancer antigen 19-9 levels. However, patients who received FOLFIRINOX rather than GA experienced higher rates of radiographic partial response (19% vs 6%; P < .01).
JAMA Surgery , commentaire, 2019