Journal Article

CA19-9 Response to First-Line Neoadjuvant FOLFIRINOX and Second-Line Gemcitabine/Nab-Paclitaxel for Patients with Operable Pancreatic Cancer

Evans, Douglas B., Tsai, Susan, George, Ben, Clarke, Callisia N., Tolat, Parag P., Kamgar, Mandana, Thalji, Sam Z., Christians, Kathleen K., Hall, William A., Smith, Zachary L., Aldakkak, Mohammed, Erickson, Beth A.

2023

Overview

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.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Albumins / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Bilirubin / CA-19-9 Antigen / Cancer therapies / Chemotherapy / Computed tomography / Deoxycytidine - therapeutic use / Fluorouracil - therapeutic use / Gemcitabine / Humans / Irinotecan / Leucovorin - therapeutic use / Medicine / Medicine & Public Health / Neoadjuvant Therapy - methods / Oncology / Oxaliplatin / Paclitaxel / Paclitaxel - adverse effects / Pancreatic cancer / Pancreatic Neoplasms - drug therapy / Pancreatic Neoplasms - surgery / Pancreatic Tumors / Sialyl Lewis a antigen / Surgery / Surgical Oncology