Increased Rate of Complete Pathologic Response After Neoadjuvant FOLFIRINOX for BRCA Mutation Carriers with Borderline R
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ORIGINAL ARTICLE – PANCREATIC TUMORS
Increased Rate of Complete Pathologic Response After Neoadjuvant FOLFIRINOX for BRCA Mutation Carriers with Borderline Resectable Pancreatic Cancer Talia Golan, MD1, Alex Barenboim, MD2, Guy Lahat, MD2, Ido Nachmany, MD2, Yacov Goykhman, MD2, Einat Shacham-Shmueli, MD1, Naama Halpern, MD1, Eli Brazowski, MD3, Ravit Geva, MD4, Ido Wolf, MD4, Yuri Goldes, MD5, Menahem Ben-Haim, MD6, Joseph M. Klausner, MD2, and Nir Lubezky, MD2 Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel; 2Liver Surgery Unit, Department of Surgery, TelAviv Medical Center, Tel Aviv, Israel; 3Institute of Pathology, Tel-Aviv Medical Center, Tel Aviv, Israel; 4Institute of Oncology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; 5Department of Surgery, Sheba Medical Center, The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; 6Department of Surgery, Shaarey Zedek Medical Center, Jerusalem, Israel
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ABSTRACT Background. Neoadjuvant FOLFIRINOX is a standardof-care treatment for BRPC patients. Patients with gBRCAm who have demonstrated improved response to platinum-based chemotherapy may have impaired homologous repair deficiency. This study aimed to describe the pathologic complete response rate and long-term survival for patients with germline BRCA1 or BRCA2 mutation (gBRCAm) and borderline resectable pancreatic cancer (BRPC) treated with neoadjuvant FOLFIRINOX. Methods. A dual-center retrospective analysis was performed. Patients who had BRPC treated with neoadjuvant FOLFIRINOX followed by curative resection were identified from clinical databases. Pathologic complete response was defined as no viable tumor cells present in the specimen. Common founder Jewish germline BRCA1 or BRCA2 mutation was determined for available patients. Results. The 61 BRPC patients in this study underwent resection after neoadjuvant FOLFIRINOX. Analysis of BRCA mutation was performed for 39 patients, and 9
Talia Golan and Alex Barenboim are equally contributed to this work. Ó Society of Surgical Oncology 2020 First Received: 15 October 2019 N. Lubezky, MD e-mail: [email protected]
patients were found to be BRCA2 germline mutation carriers. The pathologic complete response rate was 44.4% for the gBRCAm patients and 10% for the BRCA non-carriers (p = 0.009). The median disease-free survival was not reached for the gBRCAm patients and was 7 months for the BRCA non-carriers (p = 0.03). The median overall survival was not reached for the gBRCAm patients and was 32 months for the BRCA non-carriers (p = 0.2). After a mean follow-up period of 33.7 months, all eight patients with pathologic complete response were disease-free. Conclusions. The study showed that gBRCAm patients with BRPC have an increased chance for pathologic complete response and prolonged survival after neoadjuvant FOLFIRINOX. The results support the benefit of exposing gBRCAm patients to platinum-based chemotherapy early in the course of the disease. Neoadjuvant FOLFIRINOX should be considered for BRCA carriers w
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