Modified FOLFIRINOX (mFOLFIRINOX) is one of the standard first-line therapies in borderline resectable pancreatic cancer (BRPC) and locally advanced unresectable pancreatic cancer (LAPC). However, there is no globally accepted second-line therapy following progression on mFOLFIRINOX. Patients with BRPC and LAPC (n = 647) treated with first-line mFOLFIRINOX between January 2017 and December 2020 were included in this retrospective analysis. The details of the treatment outcomes and patterns of subsequent therapy after mFOLFIRINOX were reviewed. With a median follow-up duration of 44.2 months (95% confidence interval [CI], 42.3–47.6), 322 patients exhibited disease progression on mFOLFIRINOX—locoregional progression only in 177 patients (55.0%) and distant metastasis in 145 patients (45.0%). The locoregional progression group demonstrated significantly longer post-progression survival (PPS) than that of the distant metastasis group (10.1 vs. 7.3 months, p = 0.002). In the locoregional progression group, survival outcomes did not differ between second-line chemoradiation/radiotherapy and systemic chemotherapy (progression-free survival with second-line therapy [PFS-2], 3.2 vs. 4.3 months; p = 0.649; PPS, 10.7 vs. 10.2 months; p = 0.791). In patients who received second-line systemic chemotherapy following progression on mFOLFIRINOX (n = 211), gemcitabine plus nab-paclitaxel was associated with better disease control rates (69.2% vs. 42.3%, p = 0.005) and PFS-2 (3.8 vs. 1.7 months, p = 0.035) than gemcitabine monotherapy. The current study showed the real-world practice pattern of subsequent therapy and clinical outcomes following progression on first-line mFOLFIRINOX in BRPC and LAPC. Further investigation is necessary to establish the optimal therapy after failure of mFOLFIRINOX.

中文翻译：

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一线改良 FOLFIRINOX 治疗临界可切除和局部晚期胰腺腺癌疾病进展后二线治疗的临床结果

改良型 FOLFIRINOX (mFOLFIRINOX) 是交界性可切除胰腺癌 (BRPC) 和局部晚期不可切除胰腺癌 (LAPC) 的标准一线疗法之一。然而，mFOLFIRINOX 治疗进展后尚无全球公认的二线治疗方法。本回顾性分析纳入了 2017 年 1 月至 2020 年 12 月期间接受一线 mFOLFIRINOX 治疗的 BRPC 和 LAPC 患者 (n = 647)。回顾了 mFOLFIRINOX 后的治疗结果和后续治疗模式的细节。中位随访时间为 44.2 个月（95% 置信区间 [CI]，42.3–47.6），322 名患者在 mFOLFIRINOX 治疗后出现疾病进展，其中 177 名患者（55.0%）仅出现局部进展，145 名患者（45.0%）出现远处转移。 %）。局部区域进展组的进展后生存期 (PPS) 明显长于远处转移组（10.1 个月与 7.3 个月，p = 0.002）。在局部区域进展组中，二线放化疗和全身化疗之间的生存结果没有差异（二线治疗的无进展生存期 [PFS-2]，3.2 个月与 4.3 个月；p = 0.649；PPS，10.7 vs. 10.2 个月；p = 0.791)。在 mFOLFIRINOX 治疗进展后接受二线全身化疗的患者 (n = 211) 中，吉西他滨加白蛋白结合型紫杉醇与更好的疾病控制率 (69.2% vs. 42.3%，p = 0.005) 和 PFS-2 (3.8 vs. . 1.7 个月，p = 0.035) 比吉西他滨单一疗法长。当前的研究显示了 BRPC 和 LAPC 一线 mFOLFIRINOX 进展后后续治疗和临床结果的现实世界实践模式。 mFOLFIRINOX 失败后需要进一步研究以确定最佳治疗方案。