Benefit of Gemcitabine/Nab-Paclitaxel Rescue of Patients With Borderline Resectable or Locally Advanced Pancreatic Adenocarcinoma After Early Failure of FOLFIRINOX

OBJECTIVES: Neoadjuvant therapy (NT) is used for advanced pancreatic ductal adenocarcinoma (PDAC). No clear guidelines exist for switching therapies when patients do not respond to initial NT. We sought to characterize patients who underwent early switch from FOLFIRINOX to gemcitabine/nab-paclitaxel (GA) as NT for PDAC. METHODS: We identified patients at a single institution switched from FFX to GA within the first 4 months of NT for PDAC during 2012–2017. We compared clinicopathologic data and oncologic outcomes. RESULTS: Of 25 patients who met criteria, 21 showed a serologic or radiographic response to GA; 11 (52%) reached resection. Responders had decreased carbohydrate antigen (CA) 19-9 levels from pre-treatment to post-GA (P = 0.036). Resected responders had significantly decreased CA 19-9 comparing pre-switch to post-GA (P = 0.048). The only predictor of GA response was pre-chemotherapy CA 19-9