NeoGemOx: Gemcitabine and oxaliplatin as neoadjuvant treatment for locally advanced, nonmetastasized pancreatic cancer

Sahora, Klaus; Kuehrer, Irene; Eisenhut, Axel; Akan, Belgin; Koellblinger, Claus; Goetzinger, Peter; Teleky, B.; Jakesz, R.; Peck‐Radosavljevic, Markus; Ba‐Ssalamah, Ahmed

doi:10.1016/j.surg.2010.07.048

Cited by 103 publications

(71 citation statements)

References 32 publications

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“…As summarized in Table 5, those regimens were gemcitabine alone, gemcitabine plus cisplatin, 5FU plus cisplatin, gemcitabine plus oxaliplatin, gemcitabine, docetaxel plus capecitabine, gemcitabine plus capecitabine, and FOLFILINOX [18][19][20][21][22][23]. The FOLFILINOX regimen consists of 5-fluorouracil, leucovorin, irinotecan and oxaliplatin.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Vaccine: Are We There Yet?

Chablani¹

2013

J Bioequiv Availab

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Section: Discussionmentioning

confidence: 99%

Breast Cancer Vaccine: Are We There Yet?

Chablani¹

2013

J Bioequiv Availab

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“…Data from prospective trials containing patients with borderline resectable disease demonstrate that the surgical resection rate ranges from 24 to 64%, and the R0 resection rate ranges from 87 to 100% [56][57][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77]. Although most of these studies are small, neoadjuvant chemoradiation appears to be associated with good potential for downstaging and R0 resection in this population, which may be in part due to careful patient selection with adequate staging studies, and strict adherence to the definition of borderline resectable.…”

Section: • Neoadjuvant Chemoradiation For Borderline Resectable Diseasementioning

confidence: 99%

“…The gemcitabine and oxaliplatin as neoadjuvant therapy for locally advanced, nonmetastatic pancreatic cancer trial (NeoGemOx) included 15 patients with borderline resectable tumors and 18 with unresectable tumors resulting in a 39% resection rate, R0 resection rate of 69% and median OS of 22 months for those who underwent resection compared with 12 months for those who did not [74]. The gemcitabine and oxaliplatin as neoadjuvant therapy for locally advanced, nonmetastatic pancreatic cancer trial (NeoGemTax) treated a similar population of 12 borderline resectable and 13 unresectable patients and a similar 32% resection rate was observed.…”

Section: • Neoadjuvant Chemotherapy (Without Radiation)mentioning

confidence: 99%

“…Neoadjuvant therapy with the intent of sterilizing the margin could be considered in patients with vascular involvement, with particular attention to restaging to tailor surgical recommendations. Several studies suggest that neoadjuvant chemoradiation may enhance margin-negative resectability rates and improve local control [37,[56][57][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77]. Unfortunately, many of the studies are confounded by inclusion of patients with locally advanced unresectable tumors and lack of strict definition of borderline resectable disease.…”

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The Role of Neoadjuvant Therapy in Pancreatic Cancer: A Review

et al. 2016

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Controversy remains regarding neoadjuvant approaches in the treatment of pancreatic cancer. Neoadjuvant therapy has several potential advantages over adjuvant therapy including earlier delivery of systemic treatment, in vivo assessment of response, increased resectability rate in borderline resectable patients and increased margin-negative resection rate. At present, there are no randomized data favoring neoadjuvant over adjuvant therapy and multiple neoadjuvant approaches are under investigation. Combination chemotherapy regimens including 5-fluorouracil, irinotecan and oxaliplatin, gemcitabine with or without abraxane, or docetaxel and capecitabine have been used in the neoadjuvant setting. Radiation and chemoradiation have also been incorporated into neoadjuvant strategies, and delivery of alternative fractionation regimens is being explored. This review provides an overview of neoadjuvant therapies for pancreatic cancer. KEYWORDS• 5-fluorouracilPancreatic adenocarcinoma is considered one of the most aggressive malignancies. Most patients are diagnosed with advanced stage disease and only 15-20% of patients are considered candidates for curative resection. An additional 5-10% is diagnosed with borderline resectable or locally advanced disease. Although surgical resection is considered the only potentially curative treatment, resection alone results in low cure rates with median overall survival (OS) rates of approximately 20 months [1,2]. Pancreatic cancer is biologically aggressive and lacks therapeutic agents that are effective against micrometastases. Even in patients who undergo complete surgical resection followed by adjuvant chemotherapy with or without radiation, the risk for systemic recurrence can be as high as 77%, and may be either locoregional or distant in nature [3].Response rates to adjuvant therapies are variable and there is no reliable method to identify which patients will respond to treatment. Nonetheless, some randomized studies demonstrate OS and disease-free survival advantages associated with adjuvant therapies for resectable pancreatic cancer [4,5].Unlike adjuvant therapy, a neoadjuvant treatment approach potentially allows for in vivo assessment of tumor response. In addition, the use of early systemic therapy prior to surgery allows treatment of radiographically undetectable metastatic disease in some patients. It has been reported that 670REviEW Russo, Ammori, Eads & Dorth future science group disease progression occurs in 45-74% following neoadjuvant chemoradiation [6][7][8][9] and 30-78% following neoadjuvant chemotherapy [10] . Noncurative surgery and its associated risks can be avoided in patients who demonstrate disease progression following n eoadjuvant therapy.Neoadjuvant treatment also has the potential to improve compliance [11] as adjuvant therapy is frequently delayed due to recovery from surgery. It is estimated that approximately 25% of patients undergoing curative resection for pancreatic cancer do not receive the planned postoperative treatment due to surgical co...

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“…In addition to evidence of a histological response in over half of patients, surgery following this neoadjuvant regimen was safe, leading to a median survival of 26.5 mo. A separate phase Ⅱ study [55] administered neoadjuvant gemcitabine plus the platinum agent oxaliplatin to 33 patients -18 with unresectable disease and 15 with borderline resectable disease. Following treatment 13/33 underwent resection with over two-thirds of these patients undergoing an R0 resection.…”

Section: Current Phase ⅲ Trialsmentioning

confidence: 99%

Adjuvant therapy in pancreatic cancer

Jones

Melling

Ghaneh

2014

WJG

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Pancreatic cancer remains one of the leading causes of cancer related death worldwide with an overall fiveyear survival of less than 5%. Potentially curative surgery, which alone can improve 5-year survival to 10%, is an option for only 10%-20% of patients at presentation owing to local invasion of the tumour or metastatic disease. Adjuvant chemotherapy has been shown to improve 5-year survival to 20%-25% but conflicting evidence remains with regards to chemoradiation. In this article we review the current evidence available from published randomised trials and discuss ongoing phase Ⅲ trials in relation to adjuvant therapy in pancreatic cancer.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Pancreatic cancer; Adjuvant; Gemcitabine; Chemotherapy; Chemoradiotherapy; Phase Ⅲ Core tip: This paper discusses every major trial undertaken in the field of adjuvant therapy in pancreatic cancer. The evolution of chemotherapeutic regimes over the past 25 years and the controversy surrounding chemoradiation are analysed, in addition to looking at the phase Ⅲ trials currently in progress.

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NeoGemOx: Gemcitabine and oxaliplatin as neoadjuvant treatment for locally advanced, nonmetastasized pancreatic cancer

Cited by 103 publications

References 32 publications

Breast Cancer Vaccine: Are We There Yet?

Breast Cancer Vaccine: Are We There Yet?

The Role of Neoadjuvant Therapy in Pancreatic Cancer: A Review

Adjuvant therapy in pancreatic cancer

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