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CHEMOTHERAPY DOSE-INTENSITY AND OUTCOMES IN RESECTED PANCREATIC CANCER
Nicholas Galouzis
*, Evelyn V. Alexander, Maria K. Fotinos, Olivia Mitchel, Lusine Mesropyan, Carrie Luu, Mohammad R. Khreiss, Taylor S. Riall
Department of Surgery, Banner - University Medical Center Tucson, Tucson, AZ
Introduction: Both FOLFIRINOX and gemcitabine/nab-paclitaxel (GA) are standard therapy for curative intent treatment in pancreatic cancer. However, both regimens are difficult to tolerate, requiring dose reduction or missed cycles in many patients. The aim of this study is to evaluate rates of dose reduction and outcomes based on dose intensity of chemotherapy received.
Methods: This is a single-institution retrospective review (2020-2024) of patients who underwent curative intent surgery and chemotherapy for pancreatic malignancy with FOLFIRINOX or GA. The total dose of chemotherapy administered over the course of treatment was recorded. Dose intensity was calculated based on standard recommended doses for each regimen. We compared outcomes inpatients who achieved a dose-intensity of
>70% of the standard dose compared to those who received <70% of the chosen regimen.
Results: There were 46 patients with complete dosing information [33 FOLFIRINOX (71.7%) and 13 GA (28.3%)]. Over the course of treatment, dose reduction occurred in 51.5% of patients receiving FOLFIRINOX and 46.2% receiving GA. Overall, 56.5% of patients met the 70% threshold (60.6% of FOLFIRINOX group and 46.2% of gemcitabine/nab-paclitaxel group). Patients who received <70% dose intensity were significantly older (73.0±7.1 vs. 65.7±11.4, p=0.01), had a higher Charlson-Comorbidity Index score (5.9±1.4 vs. 4.5±2.1, p=0.02), and more likely to have started neoadjuvant treatment but then not receive any chemotherapy postoperatively (47.1% vs. 4.3%, p<0.01) compared to those who received
>70% dose intensity. 61.5% of patients in the
>70% dose intensity group reduced their dose at some point in treatment and only 26.9% completed >5 months of chemotherapy without a dose reduction.
Figure 1 shows a significant difference in survival based on agent and the dose intensity received.
Conclusion: Nearly half the patients who receive FOLFIRINOX or GA require dose-reduction over the course of chemotherapy. Of the patients that received
>70% of the optimal chemotherapy regimen, 61.5% reduced their regimen at some point in treatment. Survival is related to dose-intensity, but the sample size is not large enough to determine the cutoff for optimal survival. Our data suggest that dose-intensity is important.
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