scholarly journals Neoadjuvant Chemotherapy Switch in Borderline Resectable/Locally Advanced Pancreatic Cancer

2021 ◽  
Author(s):  
Roberto Alva-Ruiz ◽  
Lavanya Yohanathan ◽  
Jennifer A. Yonkus ◽  
Amro M. Abdelrahman ◽  
Lindsey A. Gregory ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Advanced Pancreatic Cancer ◽  
Preoperative Treatment ◽  
Borderline Resectable ◽  
Curative Intent ◽  
Chemotherapeutic Regimen

Abstract Background Neoadjuvant chemotherapy (NAC) is an integral part of preoperative treatment for patients with borderline resectable/locally advanced (BR/LA) pancreatic ductal adenocarcinoma (PDAC). The identification of a chemotherapeutic regimen that is both effective and tolerable is critical for NAC to be of oncologic benefit. After initial first-line (FL) NAC, some patients have lack of response or therapeutic toxicities precluding further treatment with the same regimen; optimal decision making regarding this patient population is unclear. Chemotherapy switch (CS) may allow for a larger proportion of patients to undergo curative-intent resection after NAC. Methods We reviewed our surgical database for patients undergoing combinatorial NAC for BR/LA PDAC. Variant histologic exocrine carcinomas, intraductal papillary mucinous neoplasm-associated PDAC, and patients without research consent were excluded. Results Overall, 468 patients with BR/LA PDAC receiving FL chemotherapy were reviewed, of whom 70% (329/468) continued with FL chemotherapy followed by surgical resection. The remaining 30% (139/468) underwent CS, with 72% (100/139) of CS patients going on to curative-intent surgical resection. Recurrence-free survival (RFS) and overall survival (OS) were not significantly different between the resected FL and CS cohorts (30.0 vs. 19.1 months, p = 0.13, and 41.4 vs. 36.4 months, p = 0.94, respectively) and OS was significantly worse in those undergoing CS without subsequent resection (19 months, p < 0.0001). On multivariable analysis, carbohydrate antigen (CA) 19-9 and pathologic treatment responses were predictors of RFS and OS. Conclusion CS in patients undergoing NAC for BR/LA pancreatic cancer does not incur oncologic detriment. The incorporation of CS into NAC treatment sequencing may allow a greater proportion of patients to proceed to curative-intent surgery.

The efficacy of addition of chemoradiotherapy to achieve resectability in locally-advanced pancreatic cancer remaining unresectable after neoadjuvant chemotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15761-e15761
Author(s):  
Sarbajit Mukherjee ◽  
Joshua Weir ◽  
Jordan Morton ◽  
Terence S. Herman ◽  
Bilal Khalid ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Group Versus ◽  
Median Number ◽  
Locally Advanced Pancreatic Cancer ◽  
Tumor Board ◽  
Borderline Resectable ◽  
Curative Intent

e15761 Background: Although the efficacy of neoadjuvant chemotherapy (NACT) in achieving resectability in locally advanced pancreatic cancer (LAPC) has been 20-31%, many cases remain unresectable. The aim of this study is to evaluate the efficacy of adding chemo radiotherapy (CRT) to achieve resectability in LAPC that remained unresectable after NACT. Methods: Between January 2008 and December 2016, 38 patients with LAPC (borderline resectable or unresectable pancreatic cancer, BRPC or URPC) received NACT and remained unresectable; subsequently, all patients received CRT in an attempt to achieve resectability with curative-intent. The primary objective of this retrospective single institution study is to assess resection rate (RR) in these patients. The secondary objective is to assess overall survival (OS). Results: A total of 38 patients (22 male, 16 female) who were identified as BRPC (50%) or URPC (50%) at presentation as defined by multidisciplinary tumor board using pancreatic protocol CT scan received NACT and remained unresectable. The median age was 64 (56-70.5) years. The primary site was head of pancreas in 66% versus other sites in 34% . The T-stage distribution was T1 (2.6%), T2 (2.6%), T3 (34.2%) and T4 (60.6%). N0 and N1 were 63.1% and 36.9% respectively. The types of NACT included FOFIRINOX (39.5%), Gemcitabine-based (58%) and unknown (2.5%). The median number of NACT cycles was 4 (2.25-4). All patients received subsequent CRT. Only the primary tumor was targeted with a median dose of 5040 (4950-5400) cGy and a median number of fractions 18(18-28). Chemo used concurrently with radiation was 5-FU (52.5%), Xeloda (39.5%), Gemcitabine (5.5%) and unknown (2.5%). Of note, 36.8 % patients achieved resectablity (14/38). The R0 and R1 resections were 11 (28.9%) and 3 (7.9%) respectively. 52.6% patients received adjuvant chemotherapy. The OS was 17 (6-24) months in the R0 group versus 8 (7-9) months in the R1 group. For the whole group, median OS was 11.5 (7-18.25) months. Conclusions: The addition of CRT to NACT in LAPC may improve resectability leading to an OS that approximates the OS in those patients who had upfront resectable disease.

Retrospective review of FOLFIRINOX in local advanced pancreatic cancer: Single institution experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15714-e15714
Author(s):  
Ashish Manne ◽  
Sushanth Reddy ◽  
Martin Heslin ◽  
Rojymon Jacob ◽  
Selwyn M. Vickers ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Surgical Resection ◽  
Retrospective Review ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Metastatic Setting ◽  
Significant Difference ◽  
One Year

e15714 Background: Although combination of fluorouracil, irinotecan, Leucovorin and oxaliplatin [FOLFIRINOX] significantly increases survival in metastatic pancreatic cancer (MPC) compared to gemcitabine based on ACCORD trial, the efficacy and toxicities may be different in non-metastatic setting. We reviewed our institution’s experience with FOLFIRINOX in locally advanced pancreatic cancer (LAPC). Methods: We performed a retrospective review of clinical outcomes in patients diagnosed with LAPC and receiving between June 2010 and July 2015, with at least one year of follow up from diagnosis, at University of Alabama at Birmingham. Results: Total of 41 patients with ECOG performance scale of 0 or 1, who underwent neoadjuvant chemotherapy with FOLFIRINOX were assessed for clinical and pathological characteristics. Median age was 61 years (range 38-81) with 23 (56.1%) males, 28 (68.3%) Caucasians and 16 (39.0%) underwent surgery (whipple operation) post-neoadjuvant. Median OS (time of diagnosis to last follow up/death) is 83.5 months for whole cohort, survival rates are 94.9% at 1 year, 58.4% at 2 year, and 33.3% at 5 year.Median OS for those who underwent surgical resection following the chemotherapy is 38.6 months; 100% at one year, 85.1% at 2 year, 55.3% at 5 year; while median OS for those who did not undergo surgery is 21.8 months; 91.7% at one year, 41.5% at 2 year, 20.7% at 5 years. Among those who underwent surgery, the median recurrence free survival (time from surgery to relapse/progression) is 19.9 months with liver being common recurrence site (81%). There was no post-operative mortality in 30 days. Grade 3-4 toxicity occurred in 46% ( vomiting (12%), fatigue (28%) and neutropenia (54%), febrile neutropenia (9%)). There is a significant difference between surgery and non-surgery groups (p = 0.012) for improved OS by log-rank test. Conclusions: Neoadjuvant FOLFIRINOX treatment associated with high response rates leading to surgical resection in our cohort. Patients who underwent neoadjuvant chemotherapy followed by resection for LAPC have statistically significant improved OS compared to those who did not.

Neoadjuvant chemoradiation and intraoperative electron irradiation for locally unresectable/borderline resectable pancreas adenocarcinoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 327-327
Author(s):  
Jonathan Ben Ashman ◽  
Adyr A Moss ◽  
Matthew D. Callister ◽  
Kunam S Reddy ◽  
David C Mulligan ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Electron Irradiation ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Local Therapy ◽  
Borderline Resectable ◽  
Pancreas Adenocarcinoma ◽  
The Impact

327 Background: The use of preoperative therapy for pancreatic cancer remains controversial. This study reviews our experience using neoadjuvant chemotherapy and chemoradiation (CRT) followed by surgery with intraoperative electron irradiation (IOERT) for patients with borderline resectable (BR) or unresectable (UR) tumors. Methods: A retrospective review identified 48 patients (pts) with primary BR/UR pancreas adenocarcinoma treated with preop CRT with intent to proceed to curative surgery with IOERT. Seventeen patients did not undergo attempted resection and are excluded (disease progression, 12; medically inoperable, 3; declined surgery, 2). Thirty-one patients proceeded to resection attempt and are the subject of this analysis. Kaplan-Meier survival analysis was performed using log rank test for significance. Median follow up was 19 months (mo). Results: Complete resection (R0) was achieved in 11 pts, R1 in 5, and R2 or not resected (IOERT alone) in 15 patients. Twenty-six pts died (23 of disease, 2 unrelated causes, 1 uncertain). Median overall survival (OS) was 19 mo for all pts. Local progression was detected in only 5 patients (16%) while distant disease developed in 24 (77%). Resection status significantly correlated with OS; R0/R1 patients had a median survival of 23 mo vs. 10 mo for R2/unresected tumors (p = 0.002). Three-year OS was 35% vs. 0%, respectively. Survival was not influenced by tumor location, CA19-9 baseline or response, tumor size, or initial judgment of resectability (BR vs. UR). BR tumors were resectable after neoadjuvant therapy in 9 of 11 patients (R0, 8; R1, 1) while 8 of 20 initially UR tumors underwent resection (R0, 3; R1, 4; R2, 1). Conclusions: Neoadjuvant therapy combined with IOERT has the possibility to improve patient selection for surgical resection and to optimize local therapy. Although the prognosis for locally advanced pancreatic cancer remains poor, survival was superior among patients for whom R0 or R1 resection was achieved. Distant metastasis remained the dominant pattern of failure, and novel systemic agents are needed. Prospective evaluation of the impact of neoadjuvant chemotherapy, CRT, and IOERT is warranted.

Sign in / Sign up

Export Citation Format

Share Document