Management of Locally Advanced Pancreatic Cancer

Reames, Bradley N.; Blair, Alex B.; Krell, Robert W.; Groot, Vincent P.; Gemenetzis, Georgios; Padussis, James C.; Thayer, Sarah P.; Falconi, Massimo; Wolfgang, Christopher L.; Weiss, Matthew J.; Are, Chandrakanth; He, Jin

doi:10.1097/sla.0000000000003568

Cited by 51 publications

(10 citation statements)

References 43 publications

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“…12,26 A recent survey showed that there is still a substantial variation worldwide in management preferences for LAPC. 27 As discussed in several studies, serum CA 19.9 response may predict response on induction chemotherapy and patients prognosis. [28][29][30] The present studies shows that patients who underwent resection had improved serum CA 19.9 response rates, as compared to patients not undergoing resection.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, international consensus is lacking about the acceptable tumor involvement of vital vessels before deciding on surgical exploration 12,26 . A recent survey showed that there is still a substantial variation worldwide in management preferences for LAPC 27 . As discussed in several studies, serum CA 19.9 response may predict response on induction chemotherapy and patients prognosis 28–30 .…”

Section: Discussionmentioning

confidence: 99%

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Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only

et al. 2021

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“…In addition, there is still no consensus in international guidelines on the management of BRPC/LAPC. Therefore, the management frequently depends on the local surgical expertise and assessment of the multidisciplinary board [49,50].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Neoadjuvant Gemcitabine Plus Nab-Paclitaxel in Borderline Resectable and Locally Advanced Pancreatic Cancer—A Systematic Review and Meta-Analysis

Damm

Efremov

Birnbach

et al. 2021

Cancers

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Therapy with gemcitabine and nab-paclitaxel (GNP) is the most commonly used palliative chemotherapy, but its advantage in the neoadjuvant setting remains unclear. Accordingly, our aim is to evaluate the impact of first-line neoadjuvant therapy with GNP in patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC). A systematic search for published studies until August 2020 was performed. The primary endpoint included resection and R0 resection rates in the intention-to-treat population. Secondary endpoints were response rate, survival and toxicity. Among 21 studies, 950 patients who received neoadjuvant GNP were evaluated. Treatment with GNP resulted in surgical resection and R0 resection rates as follows: 49% (95% CI 30–68%) and 36% (95% CI 17–58%) for BRPC and 16% (95% CI 7–26%) and 11% (95% CI 5–19%) for LAPC, respectively. The objective response rates and the median overall survival (mOS) ranged from 0 to 67% and 12 to 30 months, respectively. Neutropenia (range 5–77%) and neuropathy (range 0–22%) were the most commonly reported grade 3 to 4 adverse events. Neoadjuvant chemotherapy with GNP can be performed safely and with valuable effects in patients with BRPC and LAPC. The utility of GNP in comparison to FOLFIRINOX in the neoadjuvant setting requires further investigation in prospective randomized trials.

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“…11 In addition, clinical staging inaccuracy could also affect how patients are treated, mainly because there is significant variation in management approaches, even among high-volume pancreatic surgeons. 12 Therefore, understanding the relationship between clinical and pathologic staging is potentially important because it could help providers make better decisions about the best treatment option for patients with PDAC.…”

mentioning

confidence: 99%

“…Unfortunately, ascertaining NAT treatment response rates in patients with PDAC is not straightforward because clinical staging inaccuracy is observed in 40%–50% of cases—in other words, current clinical staging modalities are limited in their ability to accurately identify a patient's true stage of disease 11 . In addition, clinical staging inaccuracy could also affect how patients are treated, mainly because there is significant variation in management approaches, even among high-volume pancreatic surgeons 12 . Therefore, understanding the relationship between clinical and pathologic staging is potentially important because it could help providers make better decisions about the best treatment option for patients with PDAC.…”

mentioning

confidence: 99%

Bayesian Approach to Understand the Association Between Treatment Down-staging and Survival for Patients With Pancreatic Adenocarcinoma

Costa

Cao

et al. 2021

Annals of Surgery

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Objective: To evaluate the association between staging concordance, treatment sequencing, and response to neoadjuvant therapy (NAT) on the survival of patients with pancreatic ductal adenocarcinoma (PDAC). Summary of Background Data: NAT is increasingly utilized in the management of patients with PDAC, but it is unclear whether its benefit is contingent on tumor down-staging. Methods: This was a cohort study of stage I-III PDAC patients in the National Cancer Database (2006Database ( -2015 treated with upfront resection or NAT followed by surgery. We determined staging concordance using patients' clinical and pathological staging data. For NAT patients, we used Bayesian analysis to ascertain staging concordance accounting for down-staging. Results: Among 16,597 patients treated at 979 hospitals, 13,982 had an upfront resection and 2,615 NAT followed by surgery. Overall survival (OS) at 5-years ranged from 26.0% (95% CI 24.9%-27.1%) among cT1-2N0 patients to 18.6% (17.9%-19.2%) among cT1-3Nþ ones. Patients with cT3-4 or cNþ tumors had improved OS after NAT compared to upfront surgery (all p< 0.001), while there was no difference among patients with cT1-2N0 (P ¼ 0.16) disease. Relative to accurately staged cT1-2-3Nþ or cT4 patients treated with upfront surgery, NAT was associated with a lower risk of death for Nþ; HR 0.56 (0.40-0.77) for T4 disease], even among those without tumor down-staging [HR 0.81 (0.73-0.90) for Nþ; HR 0.48 (0.39-0.60) for T4]. Conclusions: NAT is associated with improved survival for PDAC, particularly for patients with more advanced disease and regardless of down-staging. Consideration should be given to recommending NAT for all PDAC patients.

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Management of Locally Advanced Pancreatic Cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 51 publications

References 43 publications

Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only

Survival Benefit Associated With Resection of Locally Advanced Pancreatic Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only

Efficacy and Safety of Neoadjuvant Gemcitabine Plus Nab-Paclitaxel in Borderline Resectable and Locally Advanced Pancreatic Cancer—A Systematic Review and Meta-Analysis

Bayesian Approach to Understand the Association Between Treatment Down-staging and Survival for Patients With Pancreatic Adenocarcinoma

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