Surgery Improves Survival After Neoadjuvant Therapy for Borderline and Locally Advanced Pancreatic Cancer

Abstract

Objective: Neoadjuvant therapy (NAT) has become part of the multimodality treatment for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC). Summary Background Data: It is currently uncertain which are the preferable NAT regimens, who benefits from surgery, and whether more aggressive surgical strategy is motivated. Methods: A retrospective cohort analysis was performed for all patients with BRPC/LAPC discussed and planned for NAT at multidisciplinary conference at Karolinska University Hospital from 2010 to 2017. Results: Of 233 patients eligible, 168 (72%) received NAT and were reevaluated for possibility of resection. A total of 156 (67%) patients (mean 64 yrs, 53% male) had pancreatic adenocarcinoma, comprising the study group for survival analysis. LAPC was diagnosed in 132 patients (85%), BRPC in 22 (14%), and resectable tumor in 2 (1.3%). Fifty patients (40.3%) received full-dose NAT. Only 54 (34.6%) had FOLFIRINOX. The overall survival among resected patients was similar for BRPC and LAPC (median survival 15.0 vs 14.5 mo, P = 0.4; and 31.9 vs 21.8 mo, P = 0.7, respectively). Resected patients had better survival than nonresected, irrespective of the type or whether full-dose NAT was given (median survival 22.4 vs 12.7 mo; 1-, 3-, and 5-yr survival: 86.4%, 38.9%, 26.9% vs 52.2%, 1.5%, 0%, respectively (P < 0001). For all preoperative values of Ca 19-9, surgical resection had positive impact on survival. Conclusions: All patients with BRPC/LAPC who do not progress during NAT should be considered for surgical resection, irrespective of the type or dose of NAT given. Higher levels of Ca 19-9 should not be considered an absolute contraindication for resection.

FOLFIRINOX in borderline resectable and locally advanced unresectable pancreatic adenocarcinoma

“…Favorable outcomes in patients who achieved CA 19-9 response and conversion surgery were in line with the results of prior studies. 26 , 28 , 29 Tumor response and CA 19-9 response to FOLFIRINOX may be reliable interim indicators for survival outcomes. In contrast to our findings, tumor response was not associated with OS in a previous study including 194 patients.…”

The Cross-Talk Between Gut Microbiota and Lungs in Common Lung Diseases

“…Neutralization of IFN-γor adoptive transfer of Tregs significantly reduced increased mortality (Grayson et al, 2018). In another study using murine models of influenza virus and respiratory syncytial virus (Rangelova et al, 2019), significantly altered gut microbiota diversity, with a decrease in Firmicutes phyla abundance and an increase in Bacteroidetes was observed in mice infected with influenza virus or RSV. Viral lung infections also caused an increase in colonic Muc5ac levels and fecal lipocalin-2, indicating low-grade inflammation in gut (Groves et al, 2018).…”

Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward

“…Many retrospective studies have shown that among patients with locally advanced, unresectable PDAC undergoing successful conversion chemotherapy and surgical exploration, those who received resection had a substantial survival benefit as compared with non-resectable patients [44][45][46]. Patient selection in these studies was based on disease control achieved with conversion therapy, whereas resectability was assessed by exploration.…”