A recent pilot study conducted in San Diego showcased the safety and efficacy of a preoperative combination of chemotherapy and immunotherapy for patients with borderline resectable pancreatic cancer. The neoadjuvant treatment involved modified FOLFIRINOX (5-fluorouracil with leucovorin, irinotecan, and oxaliplatin) along with nivolumab (Opdivo) and yielded promising results. The median progression-free survival was 21.9 months, while the median overall survival was 34.6 months. Patients who successfully underwent surgery experienced even longer survival outcomes.
The study’s author, Zev Wainberg, emphasized the significance of administering chemotherapy and immunotherapy earlier in the course of the disease. While previous studies in metastatic settings have not been as successful, focusing on less-advanced stages could provide valuable insights into tumor biology. The approach of combining FOLFIRINOX with nivolumab in borderline resectable cases has shown potential for improving patient outcomes.
Surgical Outcomes and Patient Characteristics
Out of the 28 patients enrolled in the trial, 79% underwent surgery, with a majority achieving R0 resections. This is crucial for borderline resectable cancers, as negative margins are associated with better prognosis. The participants in the study had a median age of 67.5 years, and the majority of them had a good performance status at baseline. Throughout the treatment, patients completed a median of 5.5 cycles, and the median follow-up for survival outcomes was 25.6 months.
The primary endpoint of the study was safety, with secondary endpoints focusing on resection rates and survival outcomes. Patients who underwent surgery had longer progression-free survival and overall survival rates. The 12- and 18-month overall survival rates were higher than historical controls, demonstrating the potential benefits of the combination therapy approach. In comparison to previous studies, the current trial showed improved resection rates and reduced recurrence rates.
One notable aspect of the study was the safety profile of the treatment regimen. While half of the patients experienced grade ≥3 adverse events, these were primarily attributed to chemotherapy. Importantly, there were no significant postoperative complications, such as fistulas, which are a common concern following pancreatic cancer resection. This indicates the feasibility and tolerability of the preoperative combination therapy for borderline resectable cases.
The innovative approach of combining chemotherapy and immunotherapy in the neoadjuvant setting for borderline resectable pancreatic cancer has shown promising results in terms of safety and efficacy. The study’s findings highlight the importance of exploring new treatment strategies in less-advanced disease stages to improve patient outcomes and reduce disease recurrence. Further research and larger clinical trials are warranted to validate these results and potentially establish a new standard of care for this challenging disease.
Leave a Reply