Induction Therapy in Localized Pancreatic Cancer

Shaib, Walid Labib; Sayegh, Layal; Zhang, Chao; Belalcazar, Astrid; Ip, Andrew; Alese, Olatunji B.; Akce, Mehmet; Wu, Christina; Qu, Yuesheng; Maithel, Shishir K.; Kooby, David A.; Cardona, Kenneth; Sarmeinto, Juan M; El‐Rayes, Bassel F.

doi:10.1097/mpa.0000000000001353

Cited by 7 publications

(8 citation statements)

References 27 publications

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“…These studies suggest the efficacy of neoadjuvant treatment, which is indicated for resectable, borderline resectable, and locally advanced PDAC. Shaib et al also reported that borderline resectable PDAC that received NAC even demonstrated more favorable prognosis than resectable PDAC that underwent upfront surgery [20]. In the present study, pT1 (primary tumor size of ≤ 2.0 cm) was marginally more frequent, degree of nodal metastasis was significantly lower, and rate of distant metastasis was significantly lower at laparotomy in the NAC group.…”

Section: Discussionsupporting

confidence: 54%

Effect and limitation of neoadjuvant chemotherapy for pancreatic ductal adenocarcinoma: consideration from a new perspective

et al. 2021

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Background Effect of neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC) has remained under investigation. We investigated its effect from a unique perspective and discussed its application. Patients and methods We retrospecively analyzed consecutive 131 PDAC patients who underwent pancreatoduodenectomy and distal pancreatectomy. Clinicopathologic data at surgery and postoperative prognosis were compared between patients who underwent upfront surgery (UFS) (n = 64) and those who received NAC (n = 67), of which 62 (92.5%) received gemcitabine plus S-1 (GS). The GS regimen resulted in about 15% of partial response and 85% of stable disease in a previous study which analyzed a subset of this study subjects. Results Tumor size was marginally smaller, degree of nodal metastasis and rate of distant metastasis were significantly lower, and pathologic stage was significantly lower in the NAC group than in the UFS group. In contrast, significant differences were not observed in histopathologic features such as vessel and perineural invasions and differentiation grade. Notably, disease-free and overall survivals were similar between the two groups adjusted for the pathologic stage, suggesting that effects of NAC, including macroscopically undetectable ones such as control of micro-metastasis and devitalizing tumor cells, may not be remarkable in the majority of PDAC, at least with respect to the GS regimen. Conclusions NAC may be useful in downstaging and improving prognosis in a small subset of tumors. However, postoperative prognosis may be determined at the pathologic stage of resected specimen with or without NAC. Therefore, NAC may be applicable to borderline resectable and locally advanced PDAC for enabling surgical resection, but UFS would be desirable for primary resectable PDAC.

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Section: Discussionsupporting

confidence: 54%

Effect and limitation of neoadjuvant chemotherapy for pancreatic ductal adenocarcinoma: consideration from a new perspective

et al. 2021

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“…161 In a multicenter retrospective analysis in Japan, it was reported that the MST prolongation effect of NAT surpassed upfront sur- In addition, many single-center retrospective analyses have reported the prolongation effect of MST on NAT. 29,[164][165][166][167][168][169] Two RCTs have recently been reported, which compared the efficacies of NAT and upfront surgery for BR-PDAC. Jang et al conducted an RCT for BR-PDAC, which compared a NAT group that underwent surgery after GEM-based CRT where the surgery group underwent postoperative CRT.…”

Section: Borderline Resectable Pdacmentioning

confidence: 99%

“…In addition, many single‐center retrospective analyses have reported the prolongation effect of MST on NAT 29,164‐169 . Two RCTs have recently been reported, which compared the efficacies of NAT and upfront surgery for BR‐PDAC.…”

Section: Multidisciplinary Treatmentmentioning

confidence: 99%

Essential updates 2018/2019: Current topics in the surgical treatment of pancreatic ductal adenocarcinoma

Ishido

Hakamada

Kimura

et al. 2020

Annals of Gastroent Surgery

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Pancreatic ductal adenocarcinoma (PDAC) is highly malignant. While cancers in other organs have shown clear improvements in 5‐year survival, the 5‐year survival rate of pancreatic cancer is approximately 10%. Early relapse and metastasis are not uncommon, making it difficult to achieve an acceptable prognosis even after complete surgical resection of the pancreas. Studies have been performed on various treatments to improve the prognosis of PDAC, and multidisciplinary approaches including non‐surgical treatments have led to gradual improvement. In the present literature review, we have described the significance of anatomical and biological resectability criteria, the concept of R0 resection in surgical treatment, the feasibility of minimally invasive surgery, the remarkable development of perioperative chemotherapy, the effectiveness of conversion surgery for unresectable PDAC, and ongoing challenges in PDAC treatment. We also provide an essential update on these subjects by focusing on recent trends and topics.

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“…Besides, induction therapy helps prolong the survival of patients. A study analyzed the OS of 409 patients with localized PDAC treated with different therapies, and the result revealed that patients who underwent resection after induction therapy had a significantly longer survival time than those who had surgery directly ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Study protocol for a prospective, open-label, single-arm, phase II study on the combination of tislelizumab, nab-paclitaxel, gemcitabine, and concurrent radiotherapy as the induction therapy for patients with locally advanced and borderline resectable pancreatic cancer

Zhu

Kong

et al. 2022

Front. Oncol.

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BackgroundPancreatic ductal adenocarcinoma (PDAC) is a fatal malignancy with a low resection rate. Chemotherapy and radiotherapy (RT) are the main treatment approaches for patients with advanced pancreatic cancer, and neoadjuvant chemoradiotherapy is considered a promising strategy to increase the resection rate. Recently, immune checkpoint inhibitor (ICI) therapy has shown remarkable efficacy in several cancers. Therefore, the combination of ICI, chemotherapy, and concurrent radiotherapy is promising for patients with potentially resectable pancreatic cancer, mainly referring to locally advanced (LAPC) and borderline resectable pancreatic cancer (BRPC), to increase the chances of conversion to surgical resectability and prolong survival. This study aims to introduce the design of a clinical trial.MethodsThis is an open-label, single-arm, and single-center phase II trial. Patients with pathologically and radiographically confirmed LAPC or BRPC without prior anti-cancer treatment or severe morbidities will be enrolled. All patients will receive induction therapy and will be further evaluated by the Multiple Disciplinary Team (MDT) for the possibility of surgery. The induction therapy consists of up to four cycles of gemcitabine 1,000 mg/m2 and nab-paclitaxel 125 mg/m2via intravenous (IV) infusion on days 1 and 8, along with tislelizumab (a PD-1 monoclonal antibody) 200 mg administered through IV infusion on day 1 every 3 weeks, concurrently with stereotactic body radiation therapy (SBRT) during the third cycle of treatment. After surgery, patients without progression will receive another two to four cycles of adjuvant therapy with gemcitabine, nab-paclitaxel, and tislelizumab. The primary objectives are objective response rate (ORR) and the R0 resection rate. The secondary objectives are median overall survival (mOS), median progression free survival (mPFS), disease control rate (DCR), pathological grade of tumor tissue after therapy, and adverse reactions. Besides, we expect to explore the value of circulating tumor DNA (ctDNA) in predicting tumor response to induction therapy and survival outcome of patients.DiscussionThis is a protocol for a clinical trial that attempts to evaluate the safety and efficacy of the combination of anti-PD-1 antibody plus chemotherapy and radiotherapy as the induction therapy for LAPC and BRPC. The results of this phase II study will provide evidence for the clinical practice of this modality.Clinical Trial Registrationhttp://www.chictr.org.cn/edit.aspx?pid=53720&htm=4, identifier ChiCTR2000032955.

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Induction Therapy in Localized Pancreatic Cancer

Cited by 7 publications

References 27 publications

Effect and limitation of neoadjuvant chemotherapy for pancreatic ductal adenocarcinoma: consideration from a new perspective

Effect and limitation of neoadjuvant chemotherapy for pancreatic ductal adenocarcinoma: consideration from a new perspective

Essential updates 2018/2019: Current topics in the surgical treatment of pancreatic ductal adenocarcinoma

Study protocol for a prospective, open-label, single-arm, phase II study on the combination of tislelizumab, nab-paclitaxel, gemcitabine, and concurrent radiotherapy as the induction therapy for patients with locally advanced and borderline resectable pancreatic cancer

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