Trends in the utilization of neoadjuvant therapy for pancreatic ductal adenocarcinoma

Brown, Zachary J.; Cloyd, Jordan M.

doi:10.1002/jso.26384

Cited by 26 publications

(17 citation statements)

References 71 publications

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“…Even among patients with localized PDAC who undergo surgical resection, recurrence rates are high. Neoadjuvant therapy (NT) is increasingly utilized for patients with localized PDAC as it leads to improved margin‐negative resection rates and emerging evidence suggests possible survival benefits compared to a surgery first approach 3,4 . The delivery of NT requires expert, multidisciplinary, and patient‐centered care coordinated among numerous healthcare providers 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Impact of care fragmentation on the outcomes of patients receiving neoadjuvant and adjuvant therapy for pancreatic adenocarcinoma

Brown

Labiner

Shen

et al. 2021

Journal of Surgical Oncology

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Introduction: Neoadjuvant therapy (NT) is increasingly used for localized pancreatic ductal adenocarcinoma (PDAC). The impact of care fragmentation during NT on the outcomes of patients with PDAC is unknown.Methods: Adult patients with Stage I-III PDAC who received NT and patients who underwent surgery first followed by adjuvant therapy (AT) between 2004 and 2016 were queried from the National Cancer Database. Short-and long-term outcomes were compared between patients who received fragmented care (FC; care provided at >1 hospital) versus integrated care (IC; care at a single institution).Results: Among 6522 patients who underwent NT before pancreatectomy, 3755 (57.6%) received FC and 2767 (42.4%) received IC. While patients who received FC had a longer time to initiation of treatment (33.2 vs. 29.7 days, p < 0.001), there was no difference in median overall survival (OS) (26.7 vs. 26.5 months, p = 0.6). Among patients who underwent upfront surgery followed by AT (n = 15 291), patients who received FC had a longer time from diagnosis to undergoing surgery but less time from surgery to AT and no difference in OS (24.0 vs. 24.0 months, p = 0.910). Conclusion:Although care fragmentation was associated with slightly longer times to initiate and complete treatment among patients with localized PDAC, long-term survival outcomes were similar.

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Section: Introductionmentioning

confidence: 99%

Impact of care fragmentation on the outcomes of patients receiving neoadjuvant and adjuvant therapy for pancreatic adenocarcinoma

Brown

Labiner

Shen

et al. 2021

Journal of Surgical Oncology

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“…Support for the use of NT for localized PDAC has largely come from small prospective trials, single-institutional series, and cancer registries[ 21 ]. These studies largely demonstrated its feasibility and proposed NT as an acceptable approach for PDAC.…”

Section: Current Evidence For Ntmentioning

confidence: 99%

“…The use of NT remains the most controversial in patients with resectable PDAC and wide variation in practices exist[ 21 ]. Nevertheless, the use of NT continues to increase given the previously described rationale and increasing evidence that highlights improved outcomes.…”

Section: Opportunities For Personalized Cancer Carementioning

confidence: 99%

Neoadjuvant therapy for pancreatic ductal adenocarcinoma: Opportunities for personalized cancer care

Hamad¹,

Brown²,

Ejaz³

et al. 2021

WJG

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Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that is best treated in a multidisciplinary fashion using surgery, chemotherapy, and radiation. Adjuvant chemotherapy has shown to have a significant survival benefit in patients with resected PDAC. However, up to 50% of patients fail to receive adjuvant chemotherapy due to postoperative complications, poor patient performance status or early disease progression. In order to ensure the delivery of chemotherapy, an alternative strategy is to administer systemic treatment prior to surgery. Precision oncology refers to the application of diverse strategies to target therapies specific to characteristics of a patient’s cancer. While traditionally emphasized in selecting targeted therapies based on molecular, genetic, and radiographic biomarkers for patients with metastatic disease, the neoadjuvant setting is a prime opportunity to utilize personalized approaches. In this article, we describe the current evidence for the use of neoadjuvant therapy (NT) and highlight unique opportunities for personalized care in patients with PDAC undergoing NT.

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“…Surgery is the primary treatment modality of pancreatic malignancies. In borderline resectable or locally advanced disease, neoadjuvant systemic therapy could be offered, with the goal of disease control and downstaging to the point of feasible resection (7).…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant treatment of pancreatic carcinosarcoma: a case report and review of literature

Lalonde¹,

Wang²,

Quigley³

et al. 2022

Chin Clin Oncol

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Carcinosarcoma of the pancreas is a rare malignancy with high mortality. Diagnosis is based on pathologic demonstration of adjacent malignant epithelial and mesenchymal tissue. Due to inherent limitations of biopsy sampling, tumor heterogeneity is rarely recognized until definitive surgical resection. A 52-year-old woman presented to the emergency department with diarrhea. Abdominal CT imaging showed a 4.1×4.5 cm mass in the head of the pancreas with intrahepatic and extrahepatic ductal dilation. Endoscopic ultrasound (EUS) confirmed the mass with evidence of superior mesenteric vein involvement. Fine-needle aspiration (FNA) showed adenocarcinoma. After multi-disciplinary tumor board discussion, the patient was treated with four cycles of neoadjuvant of oxaliplatin, irinotecan, fluorouracil, and leucovorin (FOLFIRINOX) followed by 50-55 Gy photon radiation with concurrent capecitabine. Pancreaticoduodenectomy was performed after 6 months of neoadjuvant therapy. Pathologic examination revealed carcinosarcoma of the pancreas, with pathological partial response in the resected tumor. Patient has been disease-free for 15 months. Carcinosarcoma of pancreas is a rare clinical entity. There is no established systemic therapy and only two patients, inclusive of this case, have been treated with neoadjuvant chemotherapy. Here we report a case of pancreatic carcinosarcoma treated with neoadjuvant FOLFIRINOX followed by chemoradiation with pathological partial response. Modern treatment approaches for pancreatic ductal adenocarcinoma (PDAC) could be applied to this rare pathology.

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Trends in the utilization of neoadjuvant therapy for pancreatic ductal adenocarcinoma

Cited by 26 publications

References 71 publications

Impact of care fragmentation on the outcomes of patients receiving neoadjuvant and adjuvant therapy for pancreatic adenocarcinoma

Impact of care fragmentation on the outcomes of patients receiving neoadjuvant and adjuvant therapy for pancreatic adenocarcinoma

Neoadjuvant therapy for pancreatic ductal adenocarcinoma: Opportunities for personalized cancer care

Neoadjuvant treatment of pancreatic carcinosarcoma: a case report and review of literature

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