Neoadjuvant Chemotherapy Switch in Borderline Resectable/Locally Advanced Pancreatic Cancer.

Abstract

BACKGROUND:

Neoadjuvant chemotherapy (NAC) is an integral part of preoperative treatment for patients with borderline resectable/locally advanced (BR/LA) pancreatic ductal adenocarcinoma (PDAC). The identification of a chemotherapeutic regimen that is both effective and tolerable is critical for NAC to be of oncologic benefit. After initial first-line (FL) NAC, some patients have lack of response or therapeutic toxicities precluding further treatment with the same regimen; optimal decision making regarding this patient population is unclear. Chemotherapy switch (CS) may allow for a larger proportion of patients to undergo curative-intent resection after NAC.

METHODS:

We reviewed our surgical database for patients undergoing combinatorial NAC for BR/LA PDAC. Variant histologic exocrine carcinomas, intraductal papillary mucinous neoplasm-associated PDAC, and patients without research consent were excluded.

RESULTS:

Overall, 468 patients with BR/LA PDAC receiving FL chemotherapy were reviewed, of whom 70% (329/468) continued with FL chemotherapy followed by surgical resection. The remaining 30% (139/468) underwent CS, with 72% (100/139) of CS patients going on to curative-intent surgical resection. Recurrence-free survival (RFS) and overall survival (OS) were not significantly different between the resected FL and CS cohorts (30.0 vs. 19.1 months, p = 0.13, and 41.4 vs. 36.4 months, p = 0.94, respectively) and OS was significantly worse in those undergoing CS without subsequent resection (19 months, p < 0.0001). On multivariable analysis, carbohydrate antigen (CA) 19-9 and pathologic treatment responses were predictors of RFS and OS.

CONCLUSION:

CS in patients undergoing NAC for BR/LA pancreatic cancer does not incur oncologic detriment. The incorporation of CS into NAC treatment sequencing may allow a greater proportion of patients to proceed to curative-intent surgery.

• Authors: Roberto Alva-Ruiz, Lavanya Yohanathan, Jennifer A Yonkus, Amro M Abdelrahman, Lindsey A Gregory, Thorvadur R Halfdanarson, Amit Mahipal, Robert R McWilliams, Wen Wee Ma, Christopher L Hallemeier, Rondell P Graham, Travis E Grotz, Rory L Smoot, Sean P Cleary, David M Nagorney, Michael L Kendrick, Mark J Truty
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 29 Issue 3 Pg. 1579-1591 (Mar 2022) ISSN: 1534-4681 [Electronic] United States
• PMID: 34724125 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s).

Chemical References

• CA-19-9 Antigen

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• CA-19-9 Antigen
• Carcinoma, Pancreatic Ductal (drug therapy, surgery)
• Humans
• Neoadjuvant Therapy
• Pancreatic Neoplasms (drug therapy, surgery)
• Retrospective Studies