PANCREATIC ADVANCED ADENOCARCINOMA: EFFECTIVENESS OF FOLFIRINOX CHEMOTHERAPY VERSUS PACLITAXEL NANOPARTICULATE + GEMCITABINE FOR CONVERSION TO RESECABILITY AND OVERALL SURVIVAL

Introduction: Pancreatic cancer is responsible for 2% of cancers diagnosed in Brazil, whoseprevalent histopathological subtype is adenocarcinoma. In borderline disease, the use of conversion chemotherapy aims at complete resection and extending overall survival (OS). In this context, the following protocols can be performed: Folfirinox (FFX) or Paclitaxel nanoparticulate with Gemcitabine (NAP-G). Objective: Evaluate the effectiveness for resectability and global survival of the FFX vs NAP-G protocols in patients with advanced pancreatic adenocarcinoma. Method: observational and retrospective study, with a randomly selected sample, over 18 years of age, non-pregnant pacients, diagnosed with advanced pancreatic adenocarcinoma, without previous surgery and chemotherapy. The study was approved by the Ethics Committee, CAAE 13002519.8.0000.8069. Survival analysis was perfomed every 6 months (Hazard Ratio and Kaplan Meier), and Cox Regression analysis was performed for protocol efficiency (p≤0,05). Results: 40 patients were analyzed from 2016 to 2021, 22 were selected and 17 were included. In 12 (70,6%) of them the tumor was locally advanced and in 5 (29,4%) they were metastatic. Eleven patients (64,7%) underwent the FFX protocol and 5 patients the NAP-G one (29,4%). Twelve patients (70,6%) had disease progression; 4 (23,5%) were not evaluable and 1 (5,9%) had a complete response. At the end of the collection, 10 (58,8%) patients were alive and 7 (41,2%) had died. Two of them (11,8%) had their tumors converted to resectability, while 15 (88,2%) did not. The overall median OS was 20,8 months (FFX = 21,4 months; NAP-G = 6 months). The risk of death ratio (HR) for all patients reached 0,24 at 22 months, indicating that chemotherapy decreased the mortality in 76%. When evaluating the efficiency of the two treatments in relation to patient survival, none of the evaluated determinants showed a statistically significant difference (p = 0,69). Conclusion: In this sample, both treatments reduced the mortality of locally advanced and metastatic pancreatic adenocarcinoma, however, with no statistically significant difference between FFX and NAP-G, in terms of overall survival, response rate and conversion rate.