Value of CT-Guided Percutaneous Irreversible Electroporation Added to FOLFIRINOX Chemotherapy in Locally Advanced Pancreatic Cancer: A Post Hoc Comparison.

Abstract

PURPOSE:

To compare survival after CT-guided percutaneous irreversible electroporation (IRE) and folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) chemotherapy versus FOLFIRINOX only in patients with locally advanced pancreatic cancer (LAPC).

MATERIALS AND METHODS:

A post hoc comparison was performed of data derived from a prospective IRE-FOLFIRINOX cohort and a retrospective FOLFIRINOX-only cohort. All patients received a minimum of 3 cycles of FOLFIRINOX for LAPC and were considered eligible for CT-guided percutaneous IRE. Endpoints included overall survival (OS), local and distant progression-free survival, and time to progression (TTP) and were compared using stratified Kaplan-Meier analysis. Patients who received > 8 cycles of FOLFIRINOX before IRE and who had tumors > 6 cm in the FOLFIRINOX-only group were excluded.

RESULTS:

Of 103 patients with a diagnosis of LAPC, 52 were deemed eligible (n = 30 IRE-FOLFIRINOX and n = 22 FOLFIRINOX-only). Patients in the FOLFIRINOX-only arm had larger tumors (53 mm ± 19 vs 38 mm ± 7, P = .340), had more locoregional lymph node metastases (23% vs 7%, P = .622), and more often received radiotherapy (7 patients vs 2 patients, P = .027); all other baseline characteristics were comparable. Median OS was 17.0 months (range, 5-35 mo; SD = 6) for IRE-FOLFIRINOX versus 12.4 months (range, 3-22 mo; SD = 6) for FOLFIRINOX-only (P = .038). After sensitivity analyses, median OS was 17.2 months (range, 6-27 mo; SD = 6) versus 12.4 months (range, 7-32 mo; SD = 10) (P = .05). Median TTP was longer in the IRE-FOLFIRINOX group: 14.2 months (range, 5-25 mo; SD = 4) versus 5.2 months (range, 2-22; SD = 6) (P = .0001).

CONCLUSIONS:

In patients with LAPC after FOLFIRINOX chemotherapy, CT-guided percutaneous IRE may improve OS and TTP. This study may facilitate the design of randomized controlled trials to compare survival after IRE-FOLRINOX versus FOLFIRINOX-only.

• Authors: Eran van Veldhuisen, Laurien G Vroomen, Alette H Ruarus, Tyche C Derksen, Olivier R Busch, Marcus C de Jong, Geert Kazemier, Robbert S Puijk, Natasha S Sorgedrager, Jantien A Vogel, Hester J Scheffer, Krijn P van Lienden, Johanna W Wilmink, Marc G Besselink, Martijn R Meijerink
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 31 Issue 10 Pg. 1600-1608 (Oct 2020) ISSN: 1535-7732 [Electronic] United States
• PMID: 32861569 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.

Chemical References

• folfirinox
• Oxaliplatin
• Irinotecan
• Leucovorin
• Fluorouracil

Topics

• Ablation Techniques (adverse effects, mortality)
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
• Clinical Trials as Topic
• Electroporation
• Female
• Fluorouracil (administration & dosage, adverse effects)
• Humans
• Irinotecan (administration & dosage, adverse effects)
• Leucovorin (administration & dosage, adverse effects)
• Male
• Middle Aged
• Oxaliplatin (administration & dosage, adverse effects)
• Pancreatic Neoplasms (diagnostic imaging, mortality, pathology, therapy)
• Prospective Studies
• Radiography, Interventional (adverse effects, mortality)
• Retrospective Studies
• Risk Factors
• Time Factors
• Tomography, X-Ray Computed (adverse effects, mortality)
• Treatment Outcome