CA19-9 Response to First-Line Neoadjuvant FOLFIRINOX and Second-Line Gemcitabine/Nab-Paclitaxel for Patients with Operable Pancreatic Cancer. Ann Surg Oncol 2023 May;30(5):3013-3021
Date
02/15/2023Pubmed ID
36788189DOI
10.1245/s10434-022-13055-1Scopus ID
2-s2.0-85147934173 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: Response to second-line (2L) neoadjuvant therapy for operable pancreatic cancer (PC) is understudied. This study examined carbohydrate antigen 19-9 (CA19-9) response to first-line (1L) and 2L chemotherapy.
METHODS: The study identified patients with operable PC and elevated CA19-9 (≥ 35 U/mL with total bilirubin < 2 mg/dL) who received 1L FOLFIRINOX (FFX). The patients were restaged after 2 months and based on response, received additional FFX or gemcitabine/nab-paclitaxel (GnP) as part of total neoadjuvant therapy. Response was defined as a decrease in tumor size on computed tomography (CT) imaging or a decline in CA19-9 of 50% or more and preserved performance status.
RESULTS: For operable PC with an elevated CA19-9, 108 patients received 1L FFX. After 2 months of chemotherapy, the decision was made to continue FFX (FFX ≥ FFX) for 76 (70%) of the 108 patients and switch to GnP (FFX ≥ GnP)) for 32 (30%) of the patients. Of the 32 FFX ≥ GnP patients, 27 had no evidence of radiographic or biochemical (CA19-9) response to 1L FFX. Of these 27 patients, 26 (96%) demonstrated a response to 2L GnP. After 4 months of chemotherapy, 62 (82%) of the 76 FFX ≥ FFX patients had a CA19-9 response compared with 31 (97%) of the 32 FFX ≥ GnP patients (p = 0.04).
CONCLUSIONS: Lack of biochemical response to 2 months of 1L FFX may identify a subgroup of patients with a very high rate of response to 2L GnP, emphasizing the importance of assessing treatment response at 2-month intervals.
Author List
Thalji SZ, Kamgar M, George B, Aldakkak M, Christians KK, Clarke CN, Erickson BA, Hall WA, Tolat PP, Smith ZL, Evans DB, Tsai SAuthors
Kathleen K. Christians MD Professor in the Surgery department at Medical College of WisconsinCallisia N. Clarke MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin
Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Professor in the Medicine department at Medical College of Wisconsin
William Adrian Hall MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Mandana Kamgar MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Zachary Smith DO Associate Professor in the Medicine department at Medical College of Wisconsin
Parag P. Tolat MD Chief, Associate Professor in the Radiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AlbuminsAntineoplastic Combined Chemotherapy Protocols
CA-19-9 Antigen
Deoxycytidine
Fluorouracil
Humans
Leucovorin
Neoadjuvant Therapy
Paclitaxel
Pancreatic Neoplasms
