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Pancreatic Neoplasms: HELP
Articles by Janet E. Murphy
Based on 9 articles published since 2010
(Why 9 articles?)
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Between 2010 and 2020, Janet Murphy wrote the following 9 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Clinical Trial Total Neoadjuvant Therapy With FOLFIRINOX in Combination With Losartan Followed by Chemoradiotherapy for Locally Advanced Pancreatic Cancer: A Phase 2 Clinical Trial. 2019

Murphy, Janet E / Wo, Jennifer Y / Ryan, David P / Clark, Jeffrey W / Jiang, Wenqing / Yeap, Beow Y / Drapek, Lorraine C / Ly, Leilana / Baglini, Christian V / Blaszkowsky, Lawrence S / Ferrone, Cristina R / Parikh, Aparna R / Weekes, Colin D / Nipp, Ryan D / Kwak, Eunice L / Allen, Jill N / Corcoran, Ryan B / Ting, David T / Faris, Jason E / Zhu, Andrew X / Goyal, Lipika / Berger, David L / Qadan, Motaz / Lillemoe, Keith D / Talele, Nilesh / Jain, Rakesh K / DeLaney, Thomas F / Duda, Dan G / Boucher, Yves / Fernández-Del Castillo, Carlos / Hong, Theodore S. ·Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. ·JAMA Oncol · Pubmed #31145418.

ABSTRACT: Importance: Patients with locally advanced pancreatic cancer have historically poor outcomes. Evaluation of a total neoadjuvant approach is warranted. Objective: To evaluate the margin-negative (R0) resection rate of neoadjuvant FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan) and losartan followed by chemoradiotherapy for locally advanced pancreatic cancer. Design, Setting, and Participants: A single-arm phase 2 clinical trial was conducted at a large academic hospital from August 22, 2013, to May 22, 2018, among 49 patients with previously untreated locally advanced unresectable pancreatic cancer as determined by multidisciplinary review. Patients had Eastern Cooperative Oncology Group performance status 0 or 1 and adequate hematologic, renal, and hepatic function. Median follow-up for the analysis was 17.1 months (range, 5.0-53.7) among 27 patients still alive at study completion. Interventions: Patients received FOLFIRINOX and losartan for 8 cycles. Patients with radiographically resectable tumor after chemotherapy received short-course chemoradiotherapy (5 GyE × 5 with protons) with capecitabine. Patients with persistent vascular involvement received long-course chemoradiotherapy (50.4 Gy with a vascular boost to 58.8 Gy) with fluorouracil or capecitabine. Main Outcomes and Measures: R0 resection rate. Results: Of the 49 patients (26 women and 23 men; median age 63 years [range, 42-78 years]), 39 completed 8 cycles of FOLFIRINOX and losartan; 10 patients had fewer than 8 cycles due to progression (5 patients), losartan intolerance (3 patients), and toxicity (2 patients). Seven patients (16%) had short-course chemoradiotherapy while 38 (84%) had long-course chemoradiotherapy. Forty-two (86%) patients underwent attempted surgery, with R0 resection achieved in 34 of 49 patients (69%; 95% CI, 55%-82%). Overall median progression-free survival was 17.5 months (95% CI: 13.9-22.7) and median overall survival was 31.4 months (95% CI, 18.1-38.5). Among patients who underwent resection, median progression-free survival was 21.3 months (95% CI, 16.6-28.2), and median overall survival was 33.0 months (95% CI, 31.4 to not reached). Conclusions and Relevance: Total neoadjuvant therapy with FOLFIRINOX, losartan, and chemoradiotherapy provides downstaging of locally advanced pancreatic ductal adenocarcinoma and is associated with an R0 resection rate of 61%. Trial Registration: ClinicalTrials.gov identifier: NCT01821729.

2 Clinical Trial Total Neoadjuvant Therapy With FOLFIRINOX Followed by Individualized Chemoradiotherapy for Borderline Resectable Pancreatic Adenocarcinoma: A Phase 2 Clinical Trial. 2018

Murphy, Janet E / Wo, Jennifer Y / Ryan, David P / Jiang, Wenqing / Yeap, Beow Y / Drapek, Lorraine C / Blaszkowsky, Lawrence S / Kwak, Eunice L / Allen, Jill N / Clark, Jeffrey W / Faris, Jason E / Zhu, Andrew X / Goyal, Lipika / Lillemoe, Keith D / DeLaney, Thomas F / Fernández-Del Castillo, Carlos / Ferrone, Cristina R / Hong, Theodore S. ·Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. · Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston. · Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston. ·JAMA Oncol · Pubmed #29800971.

ABSTRACT: Importance: Patients with borderline-resectable pancreatic ductal adenocarcinoma have historically poor outcomes with surgery followed by adjuvant chemotherapy. Evaluation of a total neoadjuvant approach with highly active therapy is warranted. Objective: To evaluate the margin-negative (R0) resection rate in borderline-resectable pancreatic ductal adenocarcinoma after neoadjuvant FOLFIRINOX (fluorouracil, irinotecan, and oxaliplatin) therapy and individualized chemoradiotherapy. Design, Setting, and Participants: A single-arm, phase 2 clinical trial was conducted at a large academic hospital with expertise in pancreatic surgery from August 3, 2012, through August 31, 2016, among 48 patients with newly diagnosed, previously untreated, localized pancreatic cancer determined to be borderline resectable by multidisciplinary review, who had Eastern Cooperative Oncology Group performance status 0 or 1 and adequate hematologic, renal, and hepatic function. Median follow-up for the analysis was 18.0 months among the 30 patients still alive at study completion. Interventions: Patients received FOLFIRINOX for 8 cycles. Upon restaging, patients with resolution of vascular involvement received short-course chemoradiotherapy (5 Gy × 5 with protons) with capecitabine. Patients with persistent vascular involvement received long-course chemoradiotherapy with fluorouracil or capecitabine. Main Outcomes and Measures: The primary outcome was R0 resection rate; secondary outcomes were median progression-free survival (PFS) and median overall survival (OS). Results: Of the 48 eligible patients, 27 were men and 21 were women, with a median age of 62 years (range, 46-74 years). Of the 43 patients who planned to receive 8 preoperative cycles of chemotherapy, 34 (79%) were able to complete all cycles. Twenty-seven patients (56%) had short-course chemoradiotherapy, while 17 patients (35%) had long-course chemoradiotherapy. R0 resection was achieved in 31 of the 48 eligible patients (65%; 95% CI, 49%-78%). Among the 32 patients who underwent resection, the R0 resection rate was 97% (n = 31). Median PFS among all eligible patients was 14.7 months (95% CI, 10.5 to not reached), with 2-year PFS of 43%; median OS was 37.7 months (95% CI, 19.4 to not reached), with 2-year OS of 56%. Among patients who underwent resection, median PFS was 48.6 months (95% CI, 14.4 to not reached) and median OS has not been reached, with a 2-year PFS of 55% and a 2-year OS of 72%. Conclusions and Relevance: Preoperative FOLFIRINOX followed by individualized chemoradiotherapy in borderline resectable pancreatic cancer results in high rates of R0 resection and prolonged median PFS and median OS, supporting ongoing phase 3 trials. Trial Registration: ClinicalTrials.gov Identifier: NCT01591733.

3 Article Predictors of Resectability and Survival in Patients With Borderline and Locally Advanced Pancreatic Cancer who Underwent Neoadjuvant Treatment With FOLFIRINOX. 2019

Michelakos, Theodoros / Pergolini, Ilaria / Castillo, Carlos Fernández-Del / Honselmann, Kim C / Cai, Lei / Deshpande, Vikram / Wo, Jennifer Y / Ryan, David P / Allen, Jill N / Blaszkowsky, Lawrence S / Clark, Jeffrey W / Murphy, Janet E / Nipp, Ryan D / Parikh, Aparna / Qadan, Motaz / Warshaw, Andrew L / Hong, Theodore S / Lillemoe, Keith D / Ferrone, Cristina R. ·Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. · Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. · Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. · Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. ·Ann Surg · Pubmed #29227344.

ABSTRACT: OBJECTIVE: The aim of this study was to determine (1) whether preoperative factors can predict resectability of borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant FOLFIRINOX, (2) which patients might benefit from adjuvant therapy, and (3) survival differences between resected BR/LA patients who received neoadjuvant FOLFIRINOX and upfront resected patients. BACKGROUND: Patients with BR/LA PDAC are often treated with FOLFIRINOX to obtain a margin-negative resection, yet selection of patients for resection remains challenging. METHODS: Clinicopathologic data of PDAC patients surgically explored between 04/2011-11/2016 in a single institution were retrospectively collected. RESULTS: Following neoadjuvant FOLFIRINOX, 141 patients were surgically explored (BR: 49%, LA: 51%) and 110 (78%) were resected. Resected patients had lower preoperative CA 19-9 levels (21 vs 40 U/mL, P = 0.03) and smaller tumors on preoperative computed tomography (CT) scan (2.3 vs 3.0 cm, P = 0.03), but no predictors of resectability were identified. Median overall survival (OS) was 34.2 months from diagnosis for all FOLFIRINOX patients and 37.7 months for resected patients. Among resected patients, preoperative CA 19-9 >100 U/mL and >8 months between diagnosis and surgery predicted a shorter postoperative disease-free survival (DFS); Charlson comorbidity index >1, preoperative CA 19-9 >100 U/mL and tumor size (>3.0 cm on CT or >2.5 cm on pathology) predicted decreased OS. DFS and OS were significantly better for BR/LA PDAC patients treated with neoadjuvant FOLFIRINOX compared with upfront resected patients (DFS: 29.1 vs 13.7, P < 0.001; OS: 37.7 vs 25.1 months from diagnosis, P = 0.01). CONCLUSION: BR/LA PDAC patients with no progression on neoadjuvant FOLFIRINOX should be offered surgical exploration. Except size, traditional pathological parameters fail to predict survival among resected FOLFIRINOX patients. Resected FOLFIRINOX patients have survival that appears to be superior than that of resectable patients who go directly to surgery.

4 Article Real-time Genomic Characterization of Advanced Pancreatic Cancer to Enable Precision Medicine. 2018

Aguirre, Andrew J / Nowak, Jonathan A / Camarda, Nicholas D / Moffitt, Richard A / Ghazani, Arezou A / Hazar-Rethinam, Mehlika / Raghavan, Srivatsan / Kim, Jaegil / Brais, Lauren K / Ragon, Dorisanne / Welch, Marisa W / Reilly, Emma / McCabe, Devin / Marini, Lori / Anderka, Kristin / Helvie, Karla / Oliver, Nelly / Babic, Ana / Da Silva, Annacarolina / Nadres, Brandon / Van Seventer, Emily E / Shahzade, Heather A / St Pierre, Joseph P / Burke, Kelly P / Clancy, Thomas / Cleary, James M / Doyle, Leona A / Jajoo, Kunal / McCleary, Nadine J / Meyerhardt, Jeffrey A / Murphy, Janet E / Ng, Kimmie / Patel, Anuj K / Perez, Kimberly / Rosenthal, Michael H / Rubinson, Douglas A / Ryou, Marvin / Shapiro, Geoffrey I / Sicinska, Ewa / Silverman, Stuart G / Nagy, Rebecca J / Lanman, Richard B / Knoerzer, Deborah / Welsch, Dean J / Yurgelun, Matthew B / Fuchs, Charles S / Garraway, Levi A / Getz, Gad / Hornick, Jason L / Johnson, Bruce E / Kulke, Matthew H / Mayer, Robert J / Miller, Jeffrey W / Shyn, Paul B / Tuveson, David A / Wagle, Nikhil / Yeh, Jen Jen / Hahn, William C / Corcoran, Ryan B / Carter, Scott L / Wolpin, Brian M. ·Dana-Farber Cancer Institute, Boston, Massachusetts. andrew_aguirre@dfci.harvard.edu carter.scott@jimmy.harvard.edu brian_wolpin@dfci.harvard.edu. · Broad Institute of Harvard and MIT, Cambridge, Massachusetts. · Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. · Harvard Medical School, Boston, Massachusetts. · Dana-Farber Cancer Institute, Boston, Massachusetts. · Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts. · Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts. · Harvard T.H. Chan School of Public Health, Boston, Massachusetts. · Department of Biomedical Informatics, Department of Pathology, Stony Brook University, Stony Brook, New York. · Massachusetts General Hospital Cancer Center, Boston, Massachusetts. · Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Medical Affairs, Guardant Health, Inc., Redwood City, California. · BioMed Valley Discoveries, Kansas City, Missouri. · Cold Spring Harbor Laboratory, Cold Spring Harbor, New York; Lustgarten Foundation Pancreatic Cancer Research Laboratory, Cold Spring Harbor, New York. · Departments of Surgery and Pharmacology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina. ·Cancer Discov · Pubmed #29903880.

ABSTRACT: Clinically relevant subtypes exist for pancreatic ductal adenocarcinoma (PDAC), but molecular characterization is not yet standard in clinical care. We implemented a biopsy protocol to perform time-sensitive whole-exome sequencing and RNA sequencing for patients with advanced PDAC. Therapeutically relevant genomic alterations were identified in 48% (34/71) and pathogenic/likely pathogenic germline alterations in 18% (13/71) of patients. Overall, 30% (21/71) of enrolled patients experienced a change in clinical management as a result of genomic data. Twenty-six patients had germline and/or somatic alterations in DNA-damage repair genes, and 5 additional patients had mutational signatures of homologous recombination deficiency but no identified causal genomic alteration. Two patients had oncogenic in-frame

5 Article Tolerability and Long-term Outcomes of Dose-Painted Neoadjuvant Chemoradiation to Regions of Vessel Involvement in Borderline or Locally Advanced Pancreatic Cancer. 2018

Wo, Jennifer Y / Niemierko, Andrzej / Ryan, David P / Blaszkowsky, Lawrence S / Clark, Jeffrey W / Kwak, Eunice L / Lillemoe, Keith D / Drapek, Lorraine N / Zhu, Andrew X / Allen, Jill N / Faris, Jason E / Murphy, Janet E / Nipp, Ryan / Fernandez-Del Castillo, Carlos / Ferrone, Cristina R / Hong, Theodore S. ·Departments of Radiation Oncology. · Medical Oncology. · General Surgery, Massachusetts General Hospital, Boston, MA. ·Am J Clin Oncol · Pubmed #28134673.

ABSTRACT: PURPOSE: We reviewed our experience involving patients with borderline resectable or locally advanced pancreatic cancer, treated with the dose-painted (DP) boost technique to regions of vessel involvement which preclude upfront surgical resection. We evaluated patient outcomes with respect to tolerability and treatment outcomes. MATERIALS AND METHODS: We retrospectively reviewed 99 patients with borderline resectable (n=25) or locally advanced pancreatic cancer (n=74) treated with DP-neoadjuvant chemoradiation from 2010 to 2015. Tumor and regional lymph nodes were prescribed 50.4 Gy and the region around the involved blood vessel was boosted to 58.8 Gy in 28 fractions. The primary outcome was acute toxicity and late duodenal toxicity. Secondary outcomes included conversion to surgical resectability, local failure, disease-free survival, and overall survival (OS). Cox proportional hazards models were performed to evaluate for predictors of survival. RESULTS: All but 1 patient completed chemoradiation. The rates of grade 2+ and 3+ nausea were 40% and 12%, respectively. With regards to late toxicity, 5 patients developed potential RT-related grade 3+ duodenal complications including duodenal ulceration/bleeding (n=3) and duodenal stricture (n=2). With a median follow-up of 15 months, the median OS was 18.1 months. Among 99 patients in our study, 37 patients underwent surgical resection. For patients who underwent surgical resection (n=37), the median OS was 30.9 months. On multivariate analysis, only normalization of CA 19-9 post-RT was associated with improved OS. CONCLUSIONS: We found that DP-neoadjuvant chemoradiation to regions of vessel involvement is both feasible and well tolerated. In addition, we demonstrated that over one third of patients with initially deemed unresectable disease were able to undergo surgical resection after receiving neoadjuvant therapy including DP-chemoradiation.

6 Article Use of Angiotensin System Inhibitors Is Associated with Immune Activation and Longer Survival in Nonmetastatic Pancreatic Ductal Adenocarcinoma. 2017

Liu, Hao / Naxerova, Kamila / Pinter, Matthias / Incio, Joao / Lee, Hang / Shigeta, Kohei / Ho, William W / Crain, Jonathan A / Jacobson, Alex / Michelakos, Theodoros / Dias-Santos, Daniella / Zanconato, Andrea / Hong, Theodore S / Clark, Jeffrey W / Murphy, Janet E / Ryan, David P / Deshpande, Vikram / Lillemoe, Keith D / Fernandez-Del Castillo, Carlos / Downes, Michael / Evans, Ronald M / Michaelson, James / Ferrone, Cristina R / Boucher, Yves / Jain, Rakesh K. ·Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Leder Human Biology and Translational Medicine, Biology and Biomedical Sciences, Harvard Medical School, Boston, Massachusetts. · Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts. · Laboratory for Quantitative Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Gene Expression Laboratory, Salk Institute for Biological Studies in La Jolla, La Jolla, California. · Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. yves@steele.mgh.harvard.edu jain@steele.mgh.harvard.edu. ·Clin Cancer Res · Pubmed #28600474.

ABSTRACT:

7 Article Post-Whipple imaging in patients with pancreatic ductal adenocarcinoma: association with overall survival: a multivariate analysis. 2017

Elmi, Azadeh / Murphy, Janet / Hedgire, Sandeep / McDermott, Shaunagh / Abtahi, Seyed-Mahdi / Halpern, Elkan / Fernandez-Del Castillo, Carlos / Harisinghani, Mukesh. ·Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA, 02114, USA. · Division of Hematology and Oncology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA. · Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA, 02114, USA. Hedgire.Sandeep@mgh.harvard.edu. · Institute for Technology Assessment, Radiology - Data Group, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. · General and Gastrointestinal Surgery Department, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA. ·Abdom Radiol (NY) · Pubmed #28293721.

ABSTRACT: PURPOSE: To compare the survival outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) who had regular imaging surveillance with those who had clinical follow-up after Whipple. METHOD: We identified 229 patients, who underwent Whipple for resection of PDAC from 2005 to 2011, and had regular postoperative clinical follow-up at our hospital. Patients were retrospectively selected for two follow-up groups: imaging surveillance (IS) defined as routine imaging at scheduled intervals, vs. clinical (C) defined as imaging triggered by either change in clinical status or change in CA19-9. Follow-up was obtained through the hospital and Cancer Data Registry records. Survival was calculated from the date of surgery to death or last follow-up, with data censored as of March 13, 2013. Kaplan-Meier survival curves were compared using the log-rank test, and Cox regression models were used for multivariate analysis. RESULTS: Patients were followed for a mean period of 24.35 ± 2.56 months. IS-group underwent significantly more imaging (4.41 vs. 2.08 scans/year). The most frequent imaging was CT of chest and abdomen at 3-4 month interval. Univariate associations with overall survival were detected with post-Whipple ECOG status, T-stage, N-stage, tumor grade, surgical margin, recurrence, and IS. In multivariate analysis, grade, ECOG status, and recurrence were independent predictors of survival. Also, our predictor of interest, IS, was highly associated with longer survival in multivariate modeling (median overall survival, 30.4±3.85 (IS-group) vs. 17.1 ± 2.42 (C-groups) month, log-rank p = 0.002). CONCLUSION: Routine imaging surveillance was associated with prolonged overall survival post-Whipple in a multivariate model. This is a hypothesis-generating finding that should be studied prospectively and could ultimately impact surveillance guidelines.

8 Article Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. 2015

Ferrone, Cristina R / Marchegiani, Giovanni / Hong, Theodore S / Ryan, David P / Deshpande, Vikram / McDonnell, Erin I / Sabbatino, Francesco / Santos, Daniela Dias / Allen, Jill N / Blaszkowsky, Lawrence S / Clark, Jeffrey W / Faris, Jason E / Goyal, Lipika / Kwak, Eunice L / Murphy, Janet E / Ting, David T / Wo, Jennifer Y / Zhu, Andrew X / Warshaw, Andrew L / Lillemoe, Keith D / Fernández-del Castillo, Carlos. ·*Department of Surgery †Department of Radiation Oncology; and ‡Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. ·Ann Surg · Pubmed #25599322.

ABSTRACT: PURPOSE: On the basis of the ACCORD trial, FOLFIRINOX is effective in metastatic pancreatic adenocarcinoma (PDAC), making it a rational choice for locally advanced PDAC (LA). Aims of this study are to evaluate the accuracy of imaging in determining the resectability of PDAC and to determine the surgical and clinicopathologic outcomes of pancreatic resections after neoadjuvant FOLFIRINOX therapy. PATIENTS AND METHODS: Clinicopathologic data were retrospectively collected for surgical PDAC patients receiving neoadjuvant FOLFIRINOX or no neoadjuvant therapy between April 2011 and February 2014. Americas Hepato-Pancreato-Biliary Association/Society of Surgical Oncology/Society for Surgery of the Alimentary Tract consensus guidelines defined LA and borderline. Imaging was reviewed by a blinded senior pancreatic surgeon. RESULTS: Of 188 patients undergoing resection for PDAC, 40 LA/borderline received FOLFIRINOX and 87 received no neoadjuvant therapy. FOLFIRINOX resulted in a significant decrease in tumor size, yet 19 patients were still classified as LA and 9 as borderline. Despite post-FOLFIRINOX imaging suggesting continued unresectability, 92% had an R0 resection. When compared with no neoadjuvant therapy, FOLFIRINOX resulted in significantly longer operative times (393 vs 300 minutes) and blood loss (600 vs 400 mL), but significantly lower operative morbidity (36% vs 63%) and no postoperative pancreatic fistulas. Length of stay (6 vs 7 days), readmissions (20% vs 30%), and mortality were equivalent (1% vs 0%). On final pathology, the FOLFIRINOX group had a significant decrease in lymph node positivity (35% vs 79%) and perineural invasion (72% vs 95%). Median follow-up was 11 months with a significant increase in overall survival with FOLFIRINOX. CONCLUSIONS: After neoadjuvant FOLFIRINOX imaging no longer predicts unresectability. Traditional pathologic predictors of survival are improved, and morbidity is decreased in comparison to patients with clearly resectable cancers at the time of presentation.

9 Article FOLFIRINOX in locally advanced pancreatic cancer: the Massachusetts General Hospital Cancer Center experience. 2013

Faris, Jason E / Blaszkowsky, Lawrence S / McDermott, Shaunagh / Guimaraes, Alexander R / Szymonifka, Jackie / Huynh, Mai Anh / Ferrone, Cristina R / Wargo, Jennifer A / Allen, Jill N / Dias, Lauren E / Kwak, Eunice L / Lillemoe, Keith D / Thayer, Sarah P / Murphy, Janet E / Zhu, Andrew X / Sahani, Dushyant V / Wo, Jennifer Y / Clark, Jeffrey W / Fernandez-del Castillo, Carlos / Ryan, David P / Hong, Theodore S. ·Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. jfaris@partners.org ·Oncologist · Pubmed #23657686.

ABSTRACT: The objective of our retrospective institutional experience is to report the overall response rate, R0 resection rate, progression-free survival, and safety/toxicity of neoadjuvant FOLFIRINOX (5-fluorouracil [5-FU], oxaliplatin, irinotecan, and leucovorin) and chemoradiation in patients with locally advanced pancreatic cancer (LAPC). Patients with LAPC treated with FOLFIRINOX were identified via the Massachusetts General Hospital Cancer Center pharmacy database. Demographic information, clinical characteristics, and safety/tolerability data were compiled. Formal radiographic review was performed to determine overall response rates (ORRs). Twenty-two patients with LAPC began treatment with FOLFIRINOX between July 2010 and February 2012. The ORR was 27.3%, and the median progression-free survival was 11.7 months. Five of 22 patients were able to undergo R0 resections following neoadjuvant FOLFIRINOX and chemoradiation. Three of the five patients have experienced distant recurrence within 5 months. Thirty-two percent of patients required at least one emergency department visit or hospitalization while being treated with FOLFIRINOX. FOLFIRINOX possesses substantial activity in patients with LAPC. The use of FOLFIRINOX was associated with conversion to resectability in >20% of patients. However, the recurrences following R0 resection in three of five patients and the toxicities observed with the use of this regimen raise important questions about how to best treat patients with LAPC.