Extended Neoadjuvant Chemotherapy for Borderline Resectable Pancreatic Cancer Demonstrates Promising Postoperative Outcomes and Survival

Rose, J. Bart; Rocha, Flavio G.; Alseidi, Adnan; Biehl, Thomas; Moonka, Ravi; Ryan, John A.; Lin, Bruce; Picozzi, Vincent J.; Helton, Scott

doi:10.1245/s10434-014-3486-z

Cited by 127 publications

(78 citation statements)

References 43 publications

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“…These studies are difficult to interpret, as they have used various definitions of BRPAC, different induction and post-resection regimens, and, if applied, incorporated varied radiation therapy plans (38)(39)(40)(41)(42). The most active regimens for advanced disease offer the best chance of achieving downstaging and systemic disease control.…”

Section: Discussionmentioning

confidence: 99%

“…In malignancies such as rectal, esophageal and breast cancer, pCR has been associated with improved disease-free survival and OS (73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83). In PAC, a number of studies reported pathologic outcomes following neoadjuvant chemotherapy with or without fractionated radiotherapy or stereotactic body radiotherapy, and the pCR rate ranges between 2.4 and 32.0% (41,(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94). Two of these studies reported a significantly improved OS for patients who achieved pCR compared with that of patients who did not (88,89), although this finding was not confirmed by a different study (90).…”

Section: Discussionmentioning

confidence: 99%

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Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

2017

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Abstract. Pancreatic cancer is the fourth leading cause of cancer mortality and is associated with a poor overall survival even when diagnosed early and considered resectable. Complete surgical removal with negative histological margins is an independent predictor of survival and remains the only potential curative treatment. In borderline resectable pancreatic adenocarcinoma (BRPAC), preoperative systemic therapy may increase resectability and margin-negative resection rate. There is no current consensus on the optimal chemotherapy regimen for BRPAC. The present case describes a patient with BRPAC who achieved a pathological complete response to neoadjuvant FOLFIRINOX (folinic acid, fluorouracil, irinotecan and oxaliplatin), but early relapse following a pancreaticoduodenectomy without vascular resection, with an uneventful postoperative course, except for a pulmonary embolism.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

2017

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“…A study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery indicated that the OS rate was extremely high in patients who received nonsurgical anti-cancer treatment prior to surgery over 8 months or more; however, this study did not indicate the number of patients who became inoperable during that period [12]. On the other hand, Rose et al [13] reported that among 64 BR patients, 33 (52%) were UR during 24 weeks of extended neoadjuvant chemotherapy, and that the median OS of unresected patients was 15.4 months. In this study, we found that the median survival time for unresected patients whose initial diagnosis was UR or BR was 1.01 year; for resected patients, their median survival time was 3.63 years.…”

Section: Discussionmentioning

confidence: 64%

“…Satoi et al [12] reported that patients who responded well to nonsurgical therapy in the 8 months after their initial treatment did particularly well in terms of overall survival (OS) after adjuvant surgery. Rose et al [13] also reported promising postoperative outcomes and survival for BR patients who had undergone extended neoadjuvant chemotherapy (24 weeks of gemcitabine and docetaxel). Kadera et al [14] reached a similarly positive conclusion.…”

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confidence: 98%

Prolonged Neoadjuvant Therapy for Locally Advanced Pancreatic Cancer

Eguchi¹,

Yamada²,

Iwagami³

et al. 2017

Dig Surg

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Purpose: The purpose of this study was to investigate if prolonged neoadjuvant therapy, for locally advanced pancreatic cancer could be used to identify those patients who could benefit from resection surgery. Methods: Thirty-four patients with locally advanced pancreatic cancer invading the adjacent major arteries underwent chemoradiotherapy, followed by 6 months of systemic chemotherapy, unless their tumor was already resectable. After this combination treatment, surgical resection was performed on those patients with tumors judged to be at least borderline resectable. Results: Reevaluation after chemoradiotherapy revealed that, at that stage, surgery was only possible for one case; resection was successfully performed. Following 6 months of systemic chemotherapy, a further 7 patients were diagnosed with borderline resectable lesions; 4 underwent surgery with no postoperative complications. The median survival time of the patients following surgery was 3.63 years; this was reduced to approximately a third in patients not undergoing surgery (1.01 years; p = 0.0005). Conclusions: For patients with locally advanced pancreatic cancer, prolonged neoadjuvant therapy was successfully used to select candidates that could benefit from surgical resection of their tumor. Resection significantly increased the long-term survival rate.

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“…Outcomes of extended chemotherapy for 24 weeks in patients with borderline resectable tumours in the pancreatic head were reported at the 2014 asco gastrointestinal cancers meeting 30 . Of 64 patients, 39 (61%) met resectability criteria and underwent operative exploration; 31 (48%) were resected.…”

Section: Neoadjuvant Therapy In Locally Advanced Primary Unresectablementioning

confidence: 99%

Role of Neoadjuvant Therapy in the Management of Pancreatic Cancer: Is the Era of Biomarker-Directed Therapy Here?

Цветкова

Asmis

2014

Current Oncology

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Pancreatic cancer is the 4th leading cause of cancerrelated death. Complete surgical resection (CR0) is considered the only curative treatment. Most patients present with unresectable or borderline resectable disease. Many small phase i/ii trials have tried to address the role of neoadjuvant treatment using chemotherapy with or without chemoradiation in the management of locally advanced disease. However, many of them looked at the rate of CR0 resection and the feasibility of such treatment. A trend for improved overall survival has been observed in the group of patients with borderline resectable disease who completed neoadjuvant treatment. A large proportion of patients progress while on treatment, sparing them from unnecessary surgery. We searched the PubMed database (using the key words “pancreatic cancer,” or “pancreatic neoplasm,” or “pancreatic adenocarcinoma,” and “neoadjuvant treatment,” or “neoadjuvant chemotherapy,” or “neoadjuvant radiation therapy,” or “neoadjuvant chemoradiation,” or “adjuvant therapy” [all fields] and “clinical trial” or “study”) and abstracts presented at the American Society of Clinical Oncology meetings on gastrointestinal cancers. Here, we review the most recent papers that present results on neoadjuvant therapy in pancreatic cancer. All but one report used overall survival as an endpoint. Unfortunately, there are no valid biomarkers predicting tumour progression or recurrence, and response to treatment than can help to guide therapeutic choices. Our recommendation is to consider neoadjuvant treatment in cases of borderline resectable disease. In patients with primary resectable tumours, surgery followed by adjuvant treatment and enrollment on adjuvant treatment studies would be appropriate.

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Extended Neoadjuvant Chemotherapy for Borderline Resectable Pancreatic Cancer Demonstrates Promising Postoperative Outcomes and Survival

Abstract: Extended neoadjuvant chemotherapy is well tolerated by patients with borderline resectable pancreatic head adenocarcinoma, selects a subset of patients for curative surgery with low perioperative morbidity, and is associated with favorable survival.

Cited by 127 publications

References 43 publications

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

Prolonged Neoadjuvant Therapy for Locally Advanced Pancreatic Cancer

Role of Neoadjuvant Therapy in the Management of Pancreatic Cancer: Is the Era of Biomarker-Directed Therapy Here?

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