Phase II study of induction gemcitabine and S-1 followed by chemoradiotherapy and systemic chemotherapy using S-1 for locally advanced pancreatic cancer

Sudo, Kentaro; Hara, Ryusuke; Nakamura, Kazuyoshi; Kita, Emiri; Tsujimoto, Akiko; Yamaguchi, Taketo

doi:10.1007/s00280-017-3350-5

Cited by 12 publications

(17 citation statements)

References 29 publications

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“…However, patients rarely developed life-threatening infections or febrile neutropenia. The frequency of biliary tract infection (13%) was comparable to those observed in our previous prospective study (20%) 20 . The most common non-haematological toxicity was peripheral neuropathy in prospective studies 13,19 .…”

Section: Discussionsupporting

confidence: 88%

“…Further contraindications for additional CRT included tumour invasion to the gastrointestinal tract, huge tumours, massive lymph adenopathy or ascites. We performed S-1-based CRT as reported previously 7,20 . In brief, a total dose of 50.4 Gy was delivered in 28 fractions.…”

Section: Methodsmentioning

confidence: 99%

“…The daily S-1 dose was determined according to body surface area (BSA) as follows: BSA < 1.25 m 2 , 80 mg/day; 1.25 m 2 ≤ BSA < 1.50 m 2 , 100 mg/day; and 1.50 m 2 ≤ BSA, 120 mg/day. Maintenance chemotherapy was started after CRT until the patient showed disease progression or unacceptable adverse events, as reported previously 7,20 .…”

Section: Methodsmentioning

confidence: 99%

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Gemcitabine plus nab-paclitaxel for locally advanced or borderline resectable pancreatic cancer

Tsujimoto

Sudo

Nakamura

et al. 2019

Sci Rep

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Overall survival in a phase III study for metastatic pancreatic cancer has significantly improved with gemcitabine (GEM) plus nab-paclitaxel. However, to date, there is limited data on the efficacy and safety of its use for patients with locally advanced (LA) or borderline resectable pancreatic cancer (BRPC). Here, we investigated the efficacy and safety of first-line GEM plus nab-paclitaxel for LA or BRPC. We retrospectively analysed consecutive patients with pathologically confirmed, untreated LA or BRPC who started receiving first-line GEM plus nab-paclitaxel. A total of 30 patients (LA, n = 22; BRPC, n = 8) were analysed. Twelve patients (40%) without distant metastasis received additional chemoradiotherapy using S-1. Laparotomy was performed on 8 patients and 6 (20%; LA, n = 3; BR, n = 3) achieved R0 resection. Objective response rate was 44.8%. For all patients, median progression-free survival and overall survival were 14.8 and 29.9 months, respectively. Median overall survival for LA was 24.1 months with a 2-year survival rate of 50.8%. The most frequently observed grade 3 or 4 toxicities were neutropenia (73%) and biliary infection (13%). First-line GEM plus nab-paclitaxel was well-tolerated and feasible with an encouraging survival for LA or BRPC.

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

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Gemcitabine plus nab-paclitaxel for locally advanced or borderline resectable pancreatic cancer

Tsujimoto

Sudo

Nakamura

et al. 2019

Sci Rep

Self Cite

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“…However, at the same time, prognosis of patients with UR-PC who received NST alone was dramatically improved, and MST exceeded 20 months in the latest articles. 27,28 We should always compare survival analysis by NST alone when examining the prognostic effect of CS. CS is the most invasive surgical therapy.…”

Section: Discussionmentioning

confidence: 99%

Survival benefit of conversion surgery for patients with initially unresectable pancreatic cancer who responded favorably to nonsurgical treatment

Asano

Hirano

Nakamura

et al. 2018

J Hepato Biliary Pancreat

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“…More recent non-randomized studies exploring induction with modern combinations of CT over 4–8 cycles followed by CRT in LAPC have reported even more impressive results regarding resection rates (up to 89%), R0 resection rates (70–100%), and median survival (18.1–58 months) ( Table 2 ). 10 , 68 , 88 , 89 , 92 , 93 , 94 , 95 , 96 In 2018, a large French retrospective trial of highly selected patients with resected PDAC (106 BR and 97 LAPC) treated with induction FOLFIRINOX ± CRT (54 Gy in 30 fractions with concurrent 5-FU or capecitabine) was published. Significant differences were demonstrated in favour of neoadjuvant treatment with FOLFIRINOX+CRT, both in BR and LAPC populations with greatly improved median OS (57.8 versus 35.5 months; p = 0.007), R0 resection rates (89.2% versus 76.3%, p = 0.017), and ypN0 rates (76.2% versus 48.5%, p < 0.001).…”

Section: Rt For Primary Pancreatic Cancermentioning

confidence: 99%

Novel strategies using modern radiotherapy to improve pancreatic cancer outcomes: toward a new standard?

et al. 2020

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Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive solid tumours with an estimated 5-year overall survival rate of 7% for all stages combined. In this highly resistant disease that is located in the vicinity of many radiosensitive organs, the role of radiotherapy (RT) and indications for its use in this setting have been debated for a long time and are still under investigation. Although a survival benefit has yet to be clearly demonstrated for RT, it is the only technique, other than surgery, that has been demonstrated to lead to local control improvement. The adjuvant approach is now strongly challenged by neoadjuvant treatments that could spare patients with rapidly progressive systemic disease from unnecessary surgery and may increase free margin (R0) resection rates for those eligible for surgery. Recently developed dose-escalated RT treatments, designed either to maintain full-dose chemotherapy or to deliver a high biologically effective dose, particularly to areas of contact between the tumour and blood vessels, such as hypofractionated ablative RT (HFA-RT) or stereotactic body RT (SBRT), are progressively changing the treatment landscape. These modern strategies are currently being tested in prospective clinical trials with encouraging preliminary results, paving the way for more effective treatment combinations using novel targeted therapies. This review summarizes the current literature regarding the use of RT for the treatment of primary PDAC, describes the limitations of conventional RT, and discusses the emerging role of dose-escalated RT and heavy-particle RT.

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Phase II study of induction gemcitabine and S-1 followed by chemoradiotherapy and systemic chemotherapy using S-1 for locally advanced pancreatic cancer

Abstract: This regimen was feasible and highly active resulting in encouraging survival in patients with LAPC. Further investigations are warranted to elucidate the effectiveness of this treatment strategy in future studies. Clinical trials information: UMIN000006332.

Cited by 12 publications

References 29 publications

Gemcitabine plus nab-paclitaxel for locally advanced or borderline resectable pancreatic cancer

Gemcitabine plus nab-paclitaxel for locally advanced or borderline resectable pancreatic cancer

Survival benefit of conversion surgery for patients with initially unresectable pancreatic cancer who responded favorably to nonsurgical treatment

Novel strategies using modern radiotherapy to improve pancreatic cancer outcomes: toward a new standard?

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