Neoadjuvant docetaxel-based chemoradiation for resectable adenocarcinoma of the pancreas: New neoadjuvant regimen was safe and provided an interesting pathologic response

Turrini, Olivıer; Ychou, Marc; Moureau-Zabotto, Laurence; Rouanet, Philippe; Giovannini, Marc; Moutardier, Vincent; Azria, D.; Delpero, Jean‐Robert; Viret, F.

doi:10.1016/j.ejso.2010.07.003

Cited by 58 publications

(52 citation statements)

References 31 publications

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“…For the 18 studies that reported the median overall survival of 857 patients with resectable pancreatic cancer, the weighted median overall survival was 18·2 (10–50·2) months ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer

Versteijne¹,

Vogel

Besselink

et al. 2018

British Journal of Surgery

437

354

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BackgroundStudies comparing upfront surgery with neoadjuvant treatment in pancreatic cancer may report only patients who underwent resection and so survival will be skewed. The aim of this study was to report survival by intention to treat in a comparison of upfront surgery versus neoadjuvant treatment in resectable or borderline resectable pancreatic cancer.MethodsMEDLINE, Embase and the Cochrane Library were searched for studies reporting median overall survival by intention to treat in patients with resectable or borderline resectable pancreatic cancer treated with or without neoadjuvant treatment. Secondary outcomes included overall and R0 resection rate, pathological lymph node rate, reasons for unresectability and toxicity of neoadjuvant treatment.ResultsIn total, 38 studies were included with 3484 patients, of whom 1738 (49·9 per cent) had neoadjuvant treatment. The weighted median overall survival by intention to treat was 18·8 months for neoadjuvant treatment and 14·8 months for upfront surgery; the difference was larger among patients whose tumours were resected (26·1 versus 15·0 months respectively). The overall resection rate was lower with neoadjuvant treatment than with upfront surgery (66·0 versus 81·3 per cent; P < 0·001), but the R0 rate was higher (86·8 (95 per cent c.i. 84·6 to 88·7) versus 66·9 (64·2 to 69·6) per cent; P < 0·001). Reported by intention to treat, the R0 rates were 58·0 and 54·9 per cent respectively (P = 0·088). The pathological lymph node rate was 43·8 per cent after neoadjuvant therapy and 64·8 per cent in the upfront surgery group (P < 0·001). Toxicity of at least grade III was reported in up to 64 per cent of the patients.ConclusionNeoadjuvant treatment appears to improve overall survival by intention to treat, despite lower overall resection rates for resectable or borderline resectable pancreatic cancer.PROSPERO registration number: CRD42016049374.

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Section: Resultsmentioning

confidence: 99%

Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer

Versteijne¹,

Vogel

Besselink

et al. 2018

British Journal of Surgery

437

354

View full text Add to dashboard Cite

show abstract

“…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%

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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“…In the neoadjuvant setting, an increase of R0 resection, which would decrease local relapse after resection, is expected for NACRT. Many prospective non‐randomized trials of NACRT have been reported . RCTs comparing NACRT with upfront surgery, however, have not yet been fully reported, in contrast to NAC .…”

Section: Chemotherapy And/or Radiotherapy?mentioning

confidence: 99%

Neoadjuvant treatment for resectable pancreatic adenocarcinoma: What is the best protocol?

Motoi

Unno

2020

Annals of Gastroent Surgery

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Although upfront surgery has been the gold standard for pancreatic adenocarcinoma that is planned for resection, it should be compared with the alternative strategy of neoadjuvant therapy. Despite the many reports of the efficacy of neoadjuvant therapy, most of them were not comparative. Recently Prep‐02/JSAP05 study clearly demonstrated the significant survival benefit of neoadjuvant chemotherapy over upfront surgery for pancreatic adenocarcinoma that is planned for resection. These findings opened a new chapter of neoadjuvant therapy. Ongoing trials are expected to confirm the evidence. This review summarizes the past, present, and future perspectives of neoadjuvant therapy and its optimization.

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Neoadjuvant docetaxel-based chemoradiation for resectable adenocarcinoma of the pancreas: New neoadjuvant regimen was safe and provided an interesting pathologic response

Abstract: Neoadjuvant docetaxel-based chemoradiation is well-tolerated. Resected patients had a prolonged survival time. Further studies are needed to confirm our findings and determine the role of such a neoadjuvant approach.

Cited by 58 publications

References 31 publications

Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer

Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

Neoadjuvant treatment for resectable pancreatic adenocarcinoma: What is the best protocol?

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