Total neoadjuvant therapy for pancreatic adenocarcinoma increases probability for a complete pathologic response

502 Background: Neoadjuvant chemotherapy is administered to control disease, make surgical resection possible and increase the possibility of breast tissue conservation. A further advantage of neoadjuvant therapy is that it helps to assess chemo-sensitivity to a particular agent. Induction of a pathological complete response (pCR) is one of the primary goals of neoadjuvant therapy in order to achieve a better disease-free and overall survival. Experimental data suggest that BRCA1 related breast cancer may have increased sensitivity to platinum-based chemotherapy, but clinical data are limited. The aim of this study was to evaluate the frequency of complete pathologic response after neo-adjuvant treatment with cisplatin chemotherapy in women with breast cancer and a BRCA1 mutation. Methods: Twenty five women with breast cancer and a BRCA1 mutation with stage I, II, and III breast cancer between December 2006 and December 2008 were entered into this study. Patients were treated with cisplatin 75 mg/m2 intravenously every three weeks for four cycles. After chemotherapy, patients underwent surgery and were assessed for pathologic response in both the breast and axillary lymph nodes. Complete pathologic response was defined as no residual invasive disease in both the breast and axilla, however ductal carcinoma in situ was allowed. Results: Twenty five patients were enrolled in the study. Thirteen patients had tumors of greater than two centimeters (52%) and seven patients had positive lymph nodes at diagnosis (28%). Twenty two patients completed four cycles of cisplatin (88%) and three patients completed two cycles (12%). Clinical complete response was observed in eighteen patients (72%). Pathologic complete response was observed in eighteen patients (72%). Conclusions: Platinum-based chemotherapy is effective in a high proportion of patients with BRCA1-associated breast cancers. Clinical trials are warranted to determine the optimum treatment for this subgroup of breast cancer patients. No significant financial relationships to disclose.

Download Full-text

Predictors of Pathologic Response After Total Neoadjuvant Therapy in Patients With Rectal Adenocarcinoma: A National Cancer Database Analysis

Cureus ◽

10.7759/cureus.17233 ◽

2021 ◽

Author(s):

David M McDermott ◽

Sarah A Singh ◽

Paul B Renz ◽

Shaakir Hasan ◽

Josh Weir

Keyword(s):

Neoadjuvant Therapy ◽

Rectal Adenocarcinoma ◽

Pathologic Response ◽

National Cancer Database ◽

Database Analysis ◽

Total Neoadjuvant Therapy

Download Full-text

Complete Pathologic Response Predicts Disease-Free Survival for Melanoma Patients Undergoing Neoadjuvant Therapy

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.07.509 ◽

2021 ◽

Vol 233 (5) ◽

pp. S246

Author(s):

Kristen E. Rhodin ◽

Elizabeth M. Gaughan ◽

Vignesh Raman ◽

April K. Salama ◽

Brent A. Hanks ◽

...

Keyword(s):

Neoadjuvant Therapy ◽

Disease Free Survival ◽

Pathologic Response ◽

Complete Pathologic Response ◽

Free Survival ◽

Melanoma Patients ◽

Disease Free

Download Full-text

Association of total neoadjuvant therapy with major pathologic response and survival in localized pancreatic cancer: A multi-institutional analysis of 504 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.4145 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 4145-4145

Author(s):

Jashodeep Datta ◽

Amber Collier ◽

Joshua Kronenfeld ◽

Gregory Wilson ◽

Ugwuji Maduekwe ◽

...

Keyword(s):

Pancreatic Cancer ◽

Neoadjuvant Therapy ◽

Performance Status ◽

Locally Advanced ◽

Pathologic Complete Response ◽

Pathologic Response ◽

Oncologic Outcomes ◽

Borderline Resectable ◽

Total Neoadjuvant Therapy ◽

To Receive

4145 Background: Despite increased utilization of neoadjuvant therapy for pancreatic cancer (PC), a substantial proportion of patients never receive adjuvant therapy. We examined if total neoadjuvant therapy (TNT) would facilitate delivery of all prescribed (≥6 months) non-surgical therapy (NST: chemotherapy ± radiation) to improve oncologic outcomes. Methods: Patients receiving neoadjuvant FOLFIRINOX or gemcitabine/nab-paclitaxel ±radiation followed by pancreatectomy at 7 centers were reviewed. Patients receiving TNT (≥6 months NST pre-resection) were compared to those receiving < 6 months ( < TNT). Primary outcomes were major (complete/near-complete) pathologic response (MPR) and overall survival (OS). Results: Of 504 patients, 105 (21%) were selected for TNT. TNT and < TNT patients had similar performance status and rates of borderline resectable/locally advanced disease (82% vs. 80%). TNT patients were significantly more likely to receive ≥6 months NST (100% vs. 31%; p < 0.001) vs. < TNT. While selection of chemotherapy regimen (FOLFIRINOX or gemcitabine/nab-paclitaxel) did not differ between TNT and < TNT cohorts, TNT patients were more likely to receive neoadjuvant radiation (44% vs. 25%, p < 0.001). Rates of vascular resection, postoperative complications, and mortality were similar between groups. TNT was associated with decreased rates of lymphovascular/perineural invasion (p = 0.002) and nodal positivity (p = 0.001), and increased rates of MPR (41% vs. 23%; p = 0.001) and pathologic complete response (13% vs. 6%; p = 0.02). TNT was associated with improved OS compared with < TNT (median 38 vs. 30 months; p = 0.039). Both MPR (median 38 [MPR] vs. 28 [limited response] months; p = 0.002) and ≥6 months NST (TNT or peri-operative) (median 38 [≥6m] vs. 26 [ < 6m] months; p = 0.001) were associated with improved OS. Addition of radiation was not associated with MPR or OS. Conclusions: The TNT approach allows more patients with localized PC to receive ≥6 months NST and is associated with improved rates of MPR and OS. TNT should be considered for all patients with operable PC when possible.

Download Full-text