Adjuvant Treatment for Resectable Pancreatic Cancer

2005 ◽  
Vol 23 (20) ◽  
pp. 4532-4537 ◽  
Author(s):  
Yu Jo Chua ◽  
David Cunningham
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Adjuvant Chemoradiotherapy ◽  
Resectable Pancreatic Cancer ◽  
Randomized Studies ◽  
The Subject ◽  
Margin Positive

There are relatively few randomized studies of adjuvant chemoradiotherapy and chemotherapy in patients with resected pancreatic adenocarcinoma. The European Study Group for Pancreatic Cancer 1 (ESPAC1) trial is the largest study of adjuvant treatment to date. The results of ESPAC1 are discussed in the context of other evidence from previous randomized studies, which have also been combined in a meta-analysis. Overall, the existing data show a clear benefit for postoperative adjuvant chemotherapy, which has not been demonstrated for adjuvant chemoradiotherapy. The subgroup of patients with resection margin positive disease did seem to benefit less from adjuvant chemotherapy, and showed a trend towards improved survival with chemoradiotherapy. Adjuvant chemoradiotherapy should be evaluated further in this latter group of patients. The optimal chemotherapy regimen for use as adjuvant treatment is the subject of ongoing trials. Other strategies which should be explored include neoadjuvant treatment and the incorporation of novel targeted agents into management.

scholarly journals Are We Sure that Adjuvant Chemotherapy is the Best Approach for Resectable Pancreatic Cancer? Are We in the Era of Neoadjuvant Treatment? A Review of Current Literature

2019 ◽  
Vol 8 (11) ◽  
pp. 1922 ◽  
Author(s):  
Oneda ◽  
Zaniboni
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Performance Status ◽  
Neoadjuvant Treatment ◽  
Early Recurrence ◽  
Current Treatment ◽  
R0 Resection ◽  
Resectable Pancreatic Cancer ◽  
Advantages And Disadvantages

The outcome of pancreatic cancer is poor, with a 9% 5-year survival rate. Current treatment recommendations in the 10%–20% of patients who present with resectable disease support upfront resection followed by adjuvant therapy. Until now, only early complete surgical (R0) resection and adjuvant chemotherapy (AC) with either FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) or nab-paclitaxel plus gemcitabine have been shown to prolong the survival. However, up to 30% of patients do not receive adjuvant therapy because of the development of early recurrence, postoperative complications, comorbidities, and reduced performance status. The aims of neoadjuvant chemotherapy (NAC) are to identify rapidly progressing patients to avoid futile surgery, eliminate micrometastases, increase the feasibility of R0 resection, and ensure the completion of multimodal treatment. Neoadjuvant treatments are effective, but there is no consensus on their use in resectable pancreatic cancer (RPC) because of its lack of a survival benefit over adjuvant therapy. In this review, we analyze the advantages and disadvantages of the two therapeutic approaches in RPC. We need studies that compare the two approaches and can identify the appropriate sequence of adjuvant therapy after neoadjuvant treatment and surgery.

O97 ADJUVANT CHEMORADIOTHERAPY IS BENEFICIAL IN MARGIN POSITIVE PATIENTS FOLLOWING NEO-ADJUVANT CHEMOTHERAPY AND SURGERY FOR LOWER OESOPHAGEAL AND GOJ ADENOCARCINOMA

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Bott ◽  
J Zylstra ◽  
M Wilkinson ◽  
W Knight ◽  
C Baker ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Adjuvant Chemoradiotherapy ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
R1 Resection ◽  
Resection Margin Status ◽  
Neo Adjuvant Chemotherapy ◽  
Margin Positive

Abstract Aim The aim of this study was to assess the survival benefit of adjuvant therapy in margin positive patients following neo-adjuvant chemotherapy and surgery for lower oesophageal and GOJ adenocarcinoma. Background & Methods The role of adjuvant therapy in oesophago-gastric adenocarcinoma patients treated by neo-adjuvant chemotherapy is contentious. In UK practice, surgical resection margin status is often used to stratify patients into receiving adjuvant treatment. Two prospectively collected UK institutional databases were combined. Patients were classified by the adjuvant therapy received. Crude and adjusted Cox regression analyses compared overall and recurrence free survival according to the adjuvant treatment, stratified by resection margin status. Recurrence patterns were assessed as a secondary outcome. Results From a total of 616 patients, 242 had positive margins. In this R1 resection group, 112 patients (46%) received adjuvant chemoradiotherapy compared to 46 patients (19%) who received adjuvant chemotherapy and 84 patients (35%) who received no adjuvant treatment. On adjusted analysis, pathological N3 status (p<0.001) and poor differentiation (p=0.024) were independently associated with overall survival. When stratified by tumour response to neo-adjuvant chemotherapy, a significant survival benefit in non-responders (Mandard Grade 4&5, adjuvant chemoradiotherapy HR 0.61 95%CI 0.38-0.97; p=0.037) was observed. Additionally, adjuvant chemoradiotherapy significantly improved recurrence free survival (HR 0.59 95%CI 0.38-0.94; p=0.026) with a specific benefit for systemic recurrence (HR 0.56 95%CI 0.33-0.94; p=0.027) in both responder (Mandard Grade 1-3) and non-responder (Mandard Grade 4&5) patient groups. Conclusion Adjuvant chemoradiotherapy improves overall survival, recurrence-free survival and systemic recurrence rates in R1 resection patients. This pattern is most pronounced in non-responders (Mandard 4&5) to neo-adjuvant chemotherapy suggesting a change in strategy to be effective for this specific patient group.

scholarly journals Clinical impact of neoadjuvant treatment in resectable pancreatic cancer: a systematic review and meta-analysis protocol

BMJ Open ◽  
2016 ◽  
Vol 6 (3) ◽  
pp. e010491 ◽  
Author(s):  
Jong-chan Lee ◽  
Soyeon Ahn ◽  
Kyu-hyun Paik ◽  
Hyoung Woo Kim ◽  
Jingu Kang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Clinical Impact ◽  
Resectable Pancreatic Cancer ◽  
Analysis Protocol

scholarly journals Potential Impact of Phellinus linteus on Adherence to Adjuvant Treatment After Curative Resection of Pancreatic Ductal Adenocarcinoma: Outcomes of a Propensity Score–Matched Analysis

2018 ◽  
Vol 18 ◽  
pp. 153473541881682 ◽  
Author(s):  
Sung Hwan Lee ◽  
Ho Kyoung Hwang ◽  
Chang Moo Kang ◽  
Woo Jung Lee
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Chemotherapy ◽  
Propensity Score ◽  
Adjuvant Treatment ◽  
Curative Resection ◽  
Neoadjuvant Treatment ◽  
Oncologic Outcomes ◽  
Ductal Adenocarcinoma ◽  
Phellinus Linteus ◽  
Medication Group

Background: Surgical resection followed by adjuvant chemotherapy is the only therapeutic option in pancreatic cancer. However, there is limited research evaluating methods of improving adherence to adjuvant treatment after curative resection. Methods: From January 1995 to December 2014, 323 patients with pancreatic cancer who underwent pancreatectomy at the Severance Hospital were enrolled in this study. We retrospectively analyzed clinicopathologic factors with propensity score matching method. Results: The final study population was 217, after excluding patients undergoing neoadjuvant treatment or palliative resection, those who died within 30 days after operation, and those lost to follow-up after discharge. Among them, 161 received adjuvant treatment after curative resection. Cox’s proportional hazard models revealed that nodal metastasis, perioperative transfusion, and completion of adjuvant treatment were significantly correlated with cancer recurrence and cancer-related death ( P < .05). Phellinus linteus (PL) medication was the only significant predictor for completion of adjuvant treatment after curative resection in logistic regression analysis ( P = .039). Disease-free and overall survival of the PL medication group were significantly higher than the no PL medication group ( P < .05). Conclusions: PL medication potentially contributed to long-term oncologic outcomes by increasing patients’ adherence to postoperative adjuvant chemotherapy, which resulted from PL medication associated with low toxicity of chemotherapy.

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