Early tumor shrinkage as a predictor of survival in patients with locally advanced pancreatic cancer treated with modified FOLFIRINOX or gemcitabine plus nab-paclitaxel combination therapy: An exploratory analysis of JCOG1407.

Authors

null

Shun Tezuka

Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan;

Shun Tezuka , Masato Ozaka , Junji Furuse , Kohei Uemura , Yusuke Sano , Kohei Nakachi , Hiroshi Imaoka , Michiaki Unno , Hirofumi Shirakawa , Satoshi Shimizu , Naoya Kato , Yasushi Kojima , Keiji Sano , Makoto Ueno

Organizations

Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan; , Japanese Foundation for Cancer Research, Tokyo, Japan; , JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan; , Department of Medical Oncology, Tochigi Cancer Center, National Cancer Center Hospital East, Utsunomiya-Shi, Japan; , Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa-Shi, Japan; , Tohoku University School of Medicine, Sendai, Japan; , Department of Hepatobiliary-Pancreatic Surgery, Tochigi Cancer Center, Utsunomiya, Japan; , Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan; , Chiba University, Graduate School of Medicine, Department of Gastroenterology, Chiba-Shi Chuo-Ku, Japan; , National Center for Global Health and Medicine, Tokyo, Japan; , Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan; , Kanagawa Cancer Center, Yokohama, Japan;

Research Funding

No funding received
None.

Background: Early tumor shrinkage (ETS) has been reported as a prognostic predictor of chemotherapy for colorectal cancer. However, few studies have examined the potential of ETS in chemotherapy for pancreatic cancer. Herein, we evaluated whether ETS could be a prognostic predictor in patients treated with modified FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) or GnP (gemcitabine plus nab-paclitaxel) for locally advanced pancreatic cancer (LAPC), as an exploratory analysis of JCOG1407, a randomized phase II selection design trial comparing modified FOLFIRINOX and GnP for LAPC. Methods: Of 126 patients enrolled in JCOG1407, 112 with measurable lesions were included in this exploratory analysis. ETS was defined as a ≥ 20% reduction in tumor diameter compared with baseline at the initial imaging assessment 6–10 weeks after initiating chemotherapy. Patients were divided into two cohorts based on their ETS status as described above: the ETS cohort that achieved ETS and the non-ETS cohort that failed to achieve ETS. The impact of ETS on overall survival (OS) was compared using multivariable Cox regression analysis in (ⅰ) the modified FOLFIRINOX group, (ⅱ) the GnP group, and (ⅲ) the overall population. Results: Herein, we included 55 patients in the modified FOLFIRINOX group and 57 in the GnP group. Notably, 14 (25.5%) and 24 (42.1%) patients achieved ETS in the modified FOLFIRINOX and GnP groups, respectively. In the modified FOLFIRINOX group, the median OS in the ETS and non-ETS cohorts was 2.5 and 1.7 years, respectively; the adjusted hazard ratio (HR) of the ETS to the non-ETS cohort for OS was 0.37 (95% confidence interval [CI], 0.15-0.93). In the GnP group, the median OS in the ETS and non-ETS cohorts was 2.0 and 1.7 years, respectively; the adjusted HR of the ETS to the non-ETS cohort for OS was 0.51 (95% CI, 0.26-1.01). In the overall population, the median OS in the ETS and non-ETS cohorts was 2.3 and 1.7 years, respectively; the adjusted HR of the ETS to the non-ETS cohort for OS was 0.45 (95% CI, 0.27-0.75). Conclusions: We noted a trend toward increased survival in patients who achieved ETS, suggesting that ETS may be a prognostic predictor in patients with LAPC treated with modified FOLFIRINOX or GnP.

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Abstract Details

Meeting

2023 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Track

Pancreatic Cancer,Hepatobiliary Cancer,Neuroendocrine/Carcinoid,Small Bowel Cancer

Sub Track

Therapeutics

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr 547)

DOI

10.1200/JCO.2023.41.4_suppl.547

Abstract #

547

Poster Bd #

C17

Abstract Disclosures