Both efficacy and tolerability are critical issues in choosing
neoadjuvant chemotherapy in patients with unresectable locally advanced
pancreatic cancer (LAPC). The optimal regimen and the impact of conversion surgery on patient survival remains insufficiently reported in Asain population. Therefore, we conducted a retrospective study aiming to evaluate the resection rate after different
induction chemotherapy regimen and its impact toward survival. All patients with
pancreatic cancer treated in our institute from 2013 to 2020, a total of 730 patients, were reviewed and 131 patients with LAPC were identified. For cohort homogeneity, 14 patients receiving induction
concurrent chemoradiotherapy initially were excluded and 117 patients receiving
induction chemotherapy were included in the study. Most patients (90 of 117, 77%) received triplet
induction chemotherapy, including the combination of S1,
leucovorin,
oxaliplatin and
gemcitabine (SLOG) in 48, modified
FOLFIRINOX in 21 and the combination of
gemcitabine,
oxaliplatin,
fluorouracil and
leucovorin (GOFL) in 21. The
tumor response rate (19%-33%), the surgical exploration rate (38%-52%) and the mOS (15.4-23.0 months) were not significantly different among the three triplets. Both GOFL and SLOG regimen had comparable efficacy and less
neutropenia as compared to mFOLFIRINOX. Conversion surgery was performed in 34 of 117 (29%) patients after
induction chemotherapy. The median overall survival (mOS) in patients with and without conversion surgery were 29.1 and 14.1 months, respectively (P<0.0001). Radiological response alone was not a reliable
indicator of successful conversion surgery. Patients who underwent conversion surgery had significantly better survival and thus highlighted the importance of surgical exploration in all patients who did not have progressive disease after
induction chemotherapy.