scholarly journals Conversion therapy, palliative chemotherapy and surgery, which of these is the best treatment for locally advanced and advanced pancreatic cancer?

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mingxing Wang ◽  
Pengfei Zhu ◽  
Zheling Chen ◽  
Liu Yang
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Chemotherapy ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Conversion Therapy

Arterial resections during pancreatectomy for locally advanced pancreatic cancer (LAPC) are feasible and superior to palliative chemotherapy

Pancreatology ◽  
2016 ◽  
Vol 16 (3) ◽  
pp. S73
Author(s):  
Marco Del Chiaro ◽  
Zeeshan Ateeb ◽  
Srinivas Sanjeevi ◽  
Sofia Westermark ◽  
Elena Rangelova ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Chemotherapy ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Locally Advanced Pancreatic Cancer

Comparison of concurrent chemoradiotherapy and chemotherapy alone for locally advanced pancreatic cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 351-351 ◽  
Author(s):  
Younak Choi ◽  
Tae-Yong Kim ◽  
Do-Youn Oh ◽  
Kyubo Kim ◽  
Eui Kyu Chie ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Clinical Outcomes ◽  
Palliative Chemotherapy ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Progression Free Survival ◽  
Positive Lymph Node ◽  
Locally Advanced Pancreatic Cancer ◽  
Hematologic Toxicity

351 Background: The optimal treatment strategy for locally advanced pancreatic cancer (LAPC), especially the role of chemoradiotherapy (CCRT), is still in debate. We compared the clinical outcomes of CCRT and palliative chemotherapy alone (CA) in patients with LAPC. Methods: We consecutively enrolled LAPC patients treated between 2003 and 2010. AJCC 7th edition was followed for the diagnostic criteria of LAPC. We retrospectively evaluated the clinical outcomes according to treatment groups (CCRT vs CA). Results: A total of 86 patients were enrolled. Median age was 60 years. ECOG PS was 0-1 in 77 (89.5%) and 2 in 9 (10.5%). Forty five patients (52.3%) were treated with CCRT and 41 patients (47.7%) with CA. Baseline characteristics were not significantly different between CCRT and CA group. In the CCRT group, gemcitabine (n=7, 15.6%), 5-FU (n=10, 22.2%), and capecitabine (n=28, 62.2%) were concurrently used with radiation. Radiation was delivered with 55.8Gy/ 31fraction. All of the CA group patients were treated with gemcitabine-based chemotherapy. Median progression free survival (PFS) and overall survival (OS) of whole patients were 6.9 months [95%CI 4.8-9.0] and 12.7 months [95%CI 11.6-14.3]. PFS and OS of CCRT versus CA was 8.9 months [95%CI 6.8-11.0] vs 3.7 months [95%CI 2.9-4.5] (p<0.001) and 15.8 months [95%CI 13.5-18.1] vs 11.3 months [95%CI 9.3-13.3] (p=0.017). In multivariate analysis, tumor size (≥3cm), positive lymph node, elevated CA 19-9, decreased serum albumin and CCRT was significant for PFS and OS (adjusted hazard ratio of CCRT was 0.424 (p=0.002) in PFS and 0.472 (p=0.014) in OS). Grade 3-4 hematologic toxicity was less frequent during CCRT period (p=0.002). Conclusions: In LAPC, patients who received CCRT show better OS and PFS compared with patients who were treated with palliative chemotherapy alone. It’s worthy to further study the role of CCRT in LAPC.

Outcomes and care patterns for advanced pancreatic cancer patients treated in tertiary vs regional/community cancer centres in Northern Alberta.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 163-163
Author(s):  
Matthew Anaka ◽  
Minji Lee ◽  
Sunita Ghosh ◽  
Winson Y. Cheung ◽  
Jennifer L. Spratlin
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Palliative Chemotherapy ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Tertiary Centre ◽  
Significant Difference ◽  
Care Patterns ◽  
Northern Alberta ◽  
Line Chemotherapy

163 Background: Cancer care in Northern Alberta (Canada) is delivered at a single tertiary cancer centre, and 11 regional and community cancer centres (RCCC). We compared outcomes and care patterns for patients with advanced pancreatic cancer (APC; locally advanced or metastatic) in Northern Alberta treated with palliative chemotherapy at either the tertiary centre or an RCCC. Methods: This is a retrospective cohort analysis of APC patients treated with palliative chemotherapy from 2012-2015 in Northern Alberta (Canada). Data were obtained from outpatient medical oncology and palliative care notes and the provincial cancer registry. Survival analysis used a multivariate Cox-regression model. All other tests were Chi-squared/Fisher’s Exact. Results: We identified 106 patients, 90 treated in the tertiary centre, and 16 in a RCCC. Baseline characteristics were not significantly different. There were significant differences in first line chemotherapy regimen use (P = 0.037), with patients treated at RCCC more likely to receive gemcitabine during the study period (68.8% vs 36.6%), and less likely gemcitabine/nab-paclitaxel (12.5% vs 36.5%) or FOLFIRINOX (18.8% vs 28.7%). Patients treated at RCCC were less likely to see an outpatient palliative care physician (P = 0.020, 6.3% vs 35.6%), or have a documented goals of care designation (P = 0.005, 12.5% vs 52.2%). There was no significant difference in overall survival in a multivariate analysis (median 199 vs 232 days, HR = 1.080, 95% CI 0.594 – 1.966). Conclusions: We found that survival was not different for APC patients treated at the tertiary vs RCCC in Northern Alberta. However there were significant differences in the use of palliative care resources and 1st line chemotherapy regimens, which represent important disparities that should be the focus for future quality improvement.

Goals of care designations in advanced pancreatic cancer patients undergoing palliative chemotherapy.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 683-683
Author(s):  
Matthew Anaka ◽  
Minji Lee ◽  
Elisa Lim ◽  
Sunita Ghosh ◽  
Winson Y. Cheung ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Health System ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Palliative Chemotherapy ◽  
Cohort Analysis ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Goals Of Care

683 Background: Discussion of goals of care (GoC) is a key part of quality care for patients with palliative cancer. Numerous studies have shown that documentation of GoC in this population remains low. In 2014, Alberta Health Services launched a health-system wide initiative to provide patients with physical copies of their GoC designation intended to be available at all health-system interactions. Here we describe rates of GoC documentation in the period surrounding this initiative. Methods: This is a retrospective cohort analysis of 240 patients with locally advanced or metastatic pancreatic cancer treated with palliative chemotherapy from 2012-2015 in Alberta, Canada. Data were obtained from outpatient electronic medical record documentation and the provincial cancer registry. Results: 63.8% (153/240) of patients had a documented GoC discussion, with 60.4% (145/240) receiving a specific GoC designation. 59.6% (143/240) of patients were referred to palliative care, with 32.5% (78/240) seen by palliative care physician. Of 334 individual GoC discussions documented, 38.6% (129/334) were by medical oncologists, 2.3% (10/334) were by radiation oncologists, 27.2% (91/334) were by palliative care, and 19.2% (64/334) were by other inpatient physicians during hospital admissions. At least 9.6% (32/334) referenced discussions that occurred prior to initial consultation with an oncology physician. Conclusions: The majority of pancreatic cancer patients undergoing palliative chemotherapy had a documented GoC designation during the study period. Providing patients with physical copies of their GoC designation may therefore represent a simple but effective means of increasing GoC documentation in the outpatient oncology setting.

scholarly journals Conversion Therapy of Unresectable Pancreatic Cancer: A Retrospective Study of the Real World

2021 ◽  
Author(s):  
Mingxing Wang ◽  
Pengfei Zhu ◽  
Zheling Chen ◽  
Liu Yang
Keyword(s):  
Pancreatic Cancer ◽  
Retrospective Study ◽  
Real World ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Progression Free Survival ◽  
Unresectable Pancreatic Cancer ◽  
Conversion Therapy ◽  
The Real ◽  
Zhejiang Provincial

Abstract Objective: A retrospective study of the real world was conducted to analyze whether patients with unresectable pancreatic cancer (URPC) can benefit from conversion therapy, and to screen out pancreatic cancer patients who are suitable for conversion therapy.Patients and Methods: Inquired about patients with URPC who visited Zhejiang Provincial People's Hospital from January 2015 to April 2021. We selected 25 patients with URPC who underwent conversion therapy, and 19 patients with locally advanced pancreatic cancer (LAPC) who directly underwent surgery to conducted a retrospective analysis. Results: The median overall survival (OS) of 25 patients with URPC who received conversion therapy was 28 months (95%CI: 15.46-40.54 months), and the median progression-free survival (PFS) was 12 months (95%CI: 9.26-14.74 months). The curative resection (R0) rate was 84% (22/25).Conclusions: Conversion therapy improves the R0 rate of patients with URPC, and prolongs OS and PFS.

scholarly journals Locally Advanced Pancreatic Cancer: Percutaneous Management Using Ablation, Brachytherapy, Intra-arterial Chemotherapy, and Intra-tumoral Immunotherapy

2021 ◽  
Vol 23 (6) ◽  
Author(s):  
Florentine E.F. Timmer ◽  
Bart Geboers ◽  
Sanne Nieuwenhuizen ◽  
Evelien A.C. Schouten ◽  
Madelon Dijkstra ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Chemotherapy ◽  
Treatment Approach ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Multimodality Treatment ◽  
Locally Advanced Pancreatic Cancer ◽  
Ductal Adenocarcinoma ◽  
Interventional Techniques ◽  
Randomized Controlled

Abstract Purpose of Review Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive neoplasms, bearing a terrible prognosis. Stage III tumors, also known as locally advanced pancreatic cancer (LAPC), are unresectable, and current palliative chemotherapy regimens have only modestly improved survival in these patients. At this stage of disease, interventional techniques may be of value and further prolong life. The aim of this review was to explore current literature on locoregional percutaneous management for LAPC. Recent Findings Locoregional percutaneous interventional techniques such as ablation, brachytherapy, and intra-arterial chemotherapy possess cytoreductive abilities and have the potential to increase survival. In addition, recent research demonstrates the immunomodulatory capacities of these treatments. This immune response may be leveraged by combining the interventional techniques with intra-tumoral immunotherapy, possibly creating a durable anti-tumor effect. This multimodality treatment approach is currently being examined in several ongoing clinical trials. Summary The use of certain interventional techniques appears to improve survival in LAPC patients and may work synergistically when combined with immunotherapy. However, definitive conclusions can only be made when large prospective (randomized controlled) trials confirm these results.

A Critical Overview of Systematic Reviews of Chemotherapy for Advanced and Locally Advanced Pancreatic Cancer using both AMSTAR2 and ROBIS as Quality Assessment Tools

2020 ◽  
Vol 15 ◽  
Author(s):  
Amit Dang ◽  
Surendar Chidirala ◽  
Prashanth Veeranki ◽  
BN Vallish
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Systematic Reviews ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Risk Of Bias ◽  
Low Risk ◽  
Locally Advanced Pancreatic Cancer ◽  
Grade 3 ◽  
Critical Overview

Background: We performed a critical overview of published systematic reviews (SRs) of chemotherapy for advanced and locally advanced pancreatic cancer, and evaluated their quality using AMSTAR2 and ROBIS tools. Materials and Methods: PubMed and Cochrane Central Library were searched for SRs on 13th June 2020. SRs with metaanalysis which included only randomized controlled trials and that had assessed chemotherapy as one of the treatment arms were included. The outcome measures, which were looked into, were progression-free survival (PFS), overall survival (OS), and adverse events (AEs) of grade 3 or above. Two reviewers independently assessed all the SRs with both ROBIS and AMSTAR2. Results: Out of the 1,879 identified records, 26 SRs were included for the overview. Most SRs had concluded that gemcitabine-based combination regimes, prolonged OS and PFS, but increased the incidence of grade 3-4 toxicities, when compared to gemcitabine monotherapy, but survival benefits were not consistent when gemcitabine was combined with molecular targeted agents. As per ROBIS, 24/26 SRs had high risk of bias, with only 1/26 SR having low risk of bias. As per AMSTAR2, 25/26 SRs had critically low, and 1/26 SR had low, confidence in the results. The study which scored ‘low’ risk of bias in ROBIS scored ‘low confidence in results’ in AMSTAR2. The inter-rater reliability for scoring the overall confidence in the SRs with AMSTAR2 and the overall domain in ROBIS was substantial; ROBIS: kappa=0.785, SEM=0.207, p<0.001; AMSTAR2: kappa=0.649, SEM=0.323, p<0.001. Conclusion: Gemcitabine-based combination regimens can prolong OS and PFS but also worsen AEs when compared to gemcitabine monotherapy. The included SRs have an overall low methodological quality and high risk of bias as per AMSTAR2 and ROBIS respectively.

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