Treatment Strategy for Borderline Resectable Pancreatic Cancer With Radiographic Artery Involvement

Hirono, Seiko; Kawai, Manabu; Okada, Ken-ichi; Miyazawa, Motoki; Shimizu, Atsushi; Kitahata, Yuji; Ueno, Masaki; Yamaue, Hiroki

doi:10.1097/mpa.0000000000000634

Cited by 41 publications

(48 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The weighted median overall survival of 819 patients with resectable pancreatic cancer was 17·7 (12–25·3) months, compared with 12·8 (11·6–16·3) months for 927 patients with borderline resectable pancreatic cancer ( Figs and ). In the largest (retrospective) study of Kato and colleagues, 63 of 624 patients (10·1 per cent) with borderline resectable pancreatic cancer also received neoadjuvant treatment and the median overall survival of these patients was not available separately.…”

Section: Resultsmentioning

confidence: 96%

See 1 more Smart Citation

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

440

354

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 96%

“…Twelve studies reported the median overall survival of 1746 patients undergoing upfront surgery for resectable or borderline resectable pancreatic cancer by intention to treat ( Figs and ). Overall, 81·3 per cent of 1746 patients underwent resection, with an overall weighted median overall survival of 14·8 (range 11·6–25·3) months.…”

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

440

354

View full text Add to dashboard Cite

show abstract

“…The MST in patients with portal venous invasion who underwent upfront surgery were 12.0 ( n = 251) and 14.7 ( n = 61) months at 2 prospective participating institutions of this study [12,13] . The MST of borderline resectable-artery patients who underwent upfront surgery/neoadjuvant therapy followed by surgical resection were 13.7 ( n = 103)/19.3 ( n = 40) months at another prospective participant institution [4] . There- 346 fore, threshold MST and expected MST were assumed to be 13.0 and 19.0 months, respectively.…”

Section: Study Design and Statistical Analysismentioning

confidence: 99%

“…However, the survival benefits of neoadjuvant therapy for BRPC patients remain controversial because of the systemically enhanced malignant character of advanced pancreatic carcinoma [3] . We previously reported that the overall survival (OS) of patients with BRPC who underwent neoadjuvant therapy followed by surgical resection tended to be better than that of patients who underwent upfront surgery [4] .…”

Section: Introductionmentioning

confidence: 99%

Effect of Neoadjuvant Nab-Paclitaxel plus Gemcitabine Therapy on Overall Survival in Patients with Borderline Resectable Pancreatic Cancer: A Prospective Multicenter Phase II Trial (NAC-GA Trial)

et al. 2017

Self Cite

View full text Add to dashboard Cite

We conducted a prospective multicenter phase II trial of patients with borderline resectable pancreatic carcinoma to investigate the efficacy of neoadjuvant nab-paclitaxel plus gemcitabine therapy on overall survival (OS). The clinical trial primarily evaluated OS time from the first day of protocol therapy as a primary endpoint. The secondary endpoints were recurrence-free survival from the first day of protocol therapy, safety of the protocol therapy (adverse effect), morbidity based on the Clavien Dindo classification of more than III, response rate, preoperative/postoperative tumor marker (CA 19-9, CEA), rate of normalization, reduction rate of the maximum standardized uptake value on positron emission tomography-computed tomography (limited to institutions where positron emission tomography-computed tomography was available), chemotherapeutic effect grade based on Evans' classification, resection rate, R0 resection rate, surgical data (operative time, blood loss, transfusion, postoperative hospital day), overall morbidity rates (reoperation, rate of readmission, mortality), patient rate in postoperative adjuvant therapy (entry rate, completion rate), dose intensity, quality of life regarding fatigue and malaise assessed by the questionnaire of FACIT-F (Japanese version), and peripheral sensory neuropathy assessed by the questionnaire of the FACT/GOG-NTX subscale (version 4; Japanese version). Sixty patients were included in the study, and 18 leading Japanese institutions and hospitals (all high-volume centers in pancreatic surgery) participated in this trial.

show abstract

“…Therefore, patients with pancreatic cancer have a poor prognosis, with an overall 5-year survival rate of <5% in the United States between 1975 and 2008 (2). No significant advances in the treatment of pancreatic cancer have been made in >10 years, largely due to of the resistance of the disease to conventional chemotherapy and radiation therapy (3)(4)(5)(6). The involvement of cancer stem cells (CSC; also termed tumor-initiating cells) in the development of chemotherapy resistance has been reported in a number of types of malignancy (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Thalidomide inhibits proliferation and epithelial‑mesenchymal transition by modulating CD133 expression in pancreatic cancer cells

Chen

Xiao

et al. 2017

Oncol Lett

View full text Add to dashboard Cite

Abstract. Pancreatic cancer is a solid malignancy with a high mortality rate, on account of the high incidence of metastasis at the time of detection. The aggressiveness of pancreatic cancer may be partly driven by cancer stem cells (CSCs), which are characterized by the ability to self-renew and recapitulate tumors in the ectopic setting. However, although a number of drugs targeting CSCs are currently under clinical investigation, few effective drugs have been developed. The present study demonstrated that thalidomide inhibited cell proliferation and metastasis in pancreatic cancer cell lines through the inhibition of epithelial mesenchymal transition. The effect of thalidomide was more pronounced in cluster of differentiation 133 (CD133) + SW1990 cells than in Capan-2 cells, in which CD133 expression was almost undetectable. The results revealed that CD133 is likely to serve a role in the antitumor effect of thalidomide and indicated that thalidomide could be developed as a CSC-specific adjuvant chemotherapy in pancreatic cancer. IntroductionPancreatic cancer is a disease with a high mortality rate that is characterized by the early metastasis to local and distant organs; the majority of patients present with unresectable disease at the time of initial diagnosis (1). Therefore, patients with pancreatic cancer have a poor prognosis, with an overall 5-year survival rate of <5% in the United States between 1975 and 2008 (2). No significant advances in the treatment of pancreatic cancer have been made in >10 years, largely due to of the resistance of the disease to conventional chemotherapy and radiation therapy (3-6). The involvement of cancer stem cells (CSC; also termed tumor-initiating cells) in the development of chemotherapy resistance has been reported in a number of types of malignancy (7-9). CSCs are a phenotypically distinct population of cells that are functionally defined by their ability to form tumors, self-renew and differentiate, as well as their resistance to chemotherapy (10,11). Therefore, the development of novel chemotherapeutic agents that are effective against CSCs is urgently required.Thalidomide is a non-barbiturate sedative and hypnotic drug with anti-angiogenic and immunomodulatory properties (12). Thalidomide is currently used in the treatment of various types of malignant tumor, including prostate cancer (13), glioblastoma (14), glioma (15), renal cell carcinoma (16) and advanced breast cancer (17). The mechanism of action of thalidomide includes the inhibition of vascular endothelial growth factor, basic fibroblast growth factor and tumor necrosis factor-α, the inhibition of angiogenesis, and the stimulation of natural killer cells (12). However, to the best of our knowledge, the use of thalidomide in the treatment of pancreatic cancer has not been assessed and the potential mechanism of thalidomide-mediated inhibition of tumor cell viability remains to be elucidated. In the present study, the effect of thalidomide on pancreatic cancer cells was examined, alongside its mechanism of ...

show abstract

Treatment Strategy for Borderline Resectable Pancreatic Cancer With Radiographic Artery Involvement

Abstract: Neoadjuvant treatment followed by surgery might provide clinical benefits for BRPC-A patients; however, the establishment of the most appropriate neoadjuvant therapy is needed by further studies.

Cited by 41 publications

References 33 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

Effect of Neoadjuvant Nab-Paclitaxel plus Gemcitabine Therapy on Overall Survival in Patients with Borderline Resectable Pancreatic Cancer: A Prospective Multicenter Phase II Trial (NAC-GA Trial)

Thalidomide inhibits proliferation and epithelial‑mesenchymal transition by modulating CD133 expression in pancreatic cancer cells

Contact Info

Product

Resources

About