Survival Trends for Resectable Pancreatic Cancer Using a Multidisciplinary Conference: the Impact of Post-operative Chemotherapy

Syed, Aslam; Carleton, Neil; Horne, Zachary D.; Dhawan, Annika; Bedi, Gurneet; Kochhar, Gursimran; Morrissey, Suzanne; Williams, Harry; Atkinson, Donald; Schiffman, Suzanne; Monga, Dulabh; Lupetin, Anthony R.; Kirichenko, Alexander; Mitre, Marcia; Dhawan, Manish; Kulkarni, Abhijit; Thakkar, Shyam

doi:10.1007/s12029-019-00303-z

Cited by 7 publications

(8 citation statements)

References 36 publications

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“…Unfortunately, there is a lack of data on the role and criteria of MDTs in PC. Syed et al [ 144 ] found that the multidisciplinary pancreas conference led to a significantly higher rate of adjuvant chemotherapy initiation than has been previously reported. Hansen et al [ 145 ] analyzed 7,015 patients with diagnosed or suspected pancreatic and duodenal tumors who received MDTs and compared the results from similar patients seen at the same hospital before the implementation of MDTs.…”

Section: Multidisciplinary Brpc Patient Teamsmentioning

confidence: 99%

Comprehensive multimodal management of borderline resectable pancreatic cancer: Current status and progress

H¹,

Li²,

Li³

et al. 2023

World J Gastrointest Surg

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Borderline resectable pancreatic cancer (BRPC) is a complex clinical entity with specific biological features. Criteria for resectability need to be assessed in combination with tumor anatomy and oncology. Neoadjuvant therapy (NAT) for BRPC patients is associated with additional survival benefits. Research is currently focused on exploring the optimal NAT regimen and more reliable ways of assessing response to NAT. More attention to management standards during NAT, including biliary drainage and nutritional support, is needed. Surgery remains the cornerstone of BRPC treatment and multidisciplinary teams can help to evaluate whether patients are suitable for surgery and provide individualized management during the perioperative period, including NAT responsiveness and the selection of surgical timing.

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Section: Multidisciplinary Brpc Patient Teamsmentioning

confidence: 99%

Comprehensive multimodal management of borderline resectable pancreatic cancer: Current status and progress

H¹,

Li²,

Li³

et al. 2023

World J Gastrointest Surg

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“…Theoretical advantages include immediate treatment of occult micrometastatic disease, improved patient selection, and better tolerance than chemotherapy administered in the postoperative setting 10–13 . Many patients have difficulty initiating or completing adjuvant chemotherapy due to postoperative complications or treatment toxicity; therefore, preoperative use may allow for improved rates of treatment completion 14,15 . Neoadjuvant chemotherapy use has steadily increased over the past two decades, from less than 5% in 2004 to more than 25% of patients undergoing pancreatectomy in 2016, and has recently been demonstrated to be efficacious in the treatment of resectable pancreatic cancer in a randomized, Phase II clinical trial 16,17 .…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13] Many patients have difficulty initiating or completing adjuvant chemotherapy due to postoperative complications or treatment toxicity; therefore, preoperative use may allow for improved rates of treatment completion. 14,15 Neoadjuvant chemotherapy use has steadily increased over the past two decades, from less than 5% in 2004 to more than 25% of patients undergoing pancreatectomy in 2016, and has recently been demonstrated to be efficacious in the treatment of resectable pancreatic cancer in a randomized, Phase II clinical trial. 16,17 However, studies have shown that its use is less prevalent in uninsured or underinsured patients, patients of lower socioeconomic status, and in patients treated at nonacademic facilities, thus raising concerns regarding disparities in care delivery.…”

Section: Introductionmentioning

confidence: 99%

Differences in receipt of multimodality therapy by race, insurance status, and socioeconomic disadvantage in patients with resected pancreatic cancer

Hao

Mitsakos

Irish

et al. 2022

Journal of Surgical Oncology

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Background and Methods: Racial and socioeconomic disparities in receipt of adjuvant chemotherapy affect patients with pancreatic cancer. However, differences in receipt of neoadjuvant chemotherapy among patients undergoing resection are not well-understood. A retrospective cross-sectional cohort of patients with resected AJCC Stage I/II pancreatic ductal adenocarcinoma was identified from the National Cancer Database (2014)(2015)(2016)(2017). Outcomes included receipt of neoadjuvant versus adjuvant chemotherapy, or receipt of either, defined as multimodality therapy and were assessed by univariate and multivariate analysis.Results: Of 19 588 patients, 5098 (26%) received neoadjuvant chemotherapy, 9624 (49.1%) received adjuvant chemotherapy only, and 4757 (24.3%) received no chemotherapy. On multivariable analysis, Black patients had lower odds of neoadjuvant chemotherapy compared to White patients (OR: 0.80, 95% CI: 0.67-0.97) but no differences in receipt of multimodality therapy (OR: 0.89, 95% CI: 0.77-1.03). Patients with Medicaid or no insurance, low educational attainment, or low median income had significantly lower odds of receiving neoadjuvant chemotherapy or multimodality therapy.Conclusions: Racial and socioeconomic disparities persist in receipt of neoadjuvant and multimodality therapy in patients with resected pancreatic adenocarcinoma.Discussion: Policy and interventional implementations are needed to bridge the continued socioeconomic and racial disparity gap in pancreatic cancer care.

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“… 5 - 9 Despite encouraging results, still about 25-48% of PDAC patients treated with curative resection, fail to receive planned adjuvant treatment due to complications, low-status performance, rejection or early recurrence. 10 - 12 Even with the addition of adjuvant therapy (CT+/−RT) after surgery, there is a high risk of systemic and/or local recurrence of approximately 63%. 13 This has led to a greater focus on the use of neoadjuvant therapy for patients without evidence of metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

Advances in neoadjuvant therapy for resectable pancreatic cancer over the past two decades

Taboada

Lominchar

Román

et al. 2021

Ann Hepatobiliary Pancreat Surg

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In the last two decades, pancreatic cancer has been undergoing important changes in its perioperative management due to the great interest in multidisciplinary management and preoperative multimodal therapy, which in numerous studies have shown promising clinical results. Although the standard of treatment for resectable pancreatic ductal adenocarcinoma (PDAC) today is surgery followed by adjuvant therapy, as it is a biologically aggressive disease, even with complete resection, it has high rates of local and distant relapse. Several retrospective and prospective phase I/II studies have opened the window for neoadjuvant therapy with chemotherapy (CT), chemoradiotherapy (CRT), or both, as an alternative treatment for resectable pancreatic cancer, with promising results. Neoadjuvant therapy could has some advantages, including early administration of systemic treatment, in vivo assessment of response to treatment, increase resectability rate in borderline patients, increase resection rate with negative margin and survival benefit. While it seems clear that even potentially resectable disease would benefit from preoperative multimodal therapy, the optimal neoadjuvant therapeutic strategy is still controversial and currently there are only recommendations for neoadjuvant treatment, in clinical guidelines such as the NCCN and ESMO, for borderline and/or locally advanced PDAC. This review provides an overview of recent studies available and how they relate to systemic treatment of resectable PDAC in the neoadjuvant setting.

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Survival Trends for Resectable Pancreatic Cancer Using a Multidisciplinary Conference: the Impact of Post-operative Chemotherapy

Cited by 7 publications

References 36 publications

Comprehensive multimodal management of borderline resectable pancreatic cancer: Current status and progress

Comprehensive multimodal management of borderline resectable pancreatic cancer: Current status and progress

Differences in receipt of multimodality therapy by race, insurance status, and socioeconomic disadvantage in patients with resected pancreatic cancer

Advances in neoadjuvant therapy for resectable pancreatic cancer over the past two decades

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