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Factors Contributing to Improved Survival Following Total Neoadjuvant Therapy for Borderline/Locally Advanced Pancreatic Cancer

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Key Points

  • In the study, 29% of patients had all 3 of the following factors: extended duration of chemotherapy before surgery, a CA 19-9 tumor marker that fell to a normal level after chemotherapy, and a major pathologic response. Their median survival time has not yet been calculated because more than half are still alive.
  • An additional 29% had 2 of these factors; their median survival was 58.6 months.
  • About 31% had 1 factor and a median survival of 29.7 months; 11% had none of these factors and a median survival of 18.5 months.

A newly published Mayo Clinic study has found that a presurgery treatment plan for patients with borderline/locally advanced pancreatic cancer undergoing total neoadjuvant therapy may improve outcomes. The findings were published by Truty et al in Annals of Surgery.

The study followed 194 patients who received chemotherapy followed by radiation and surgery over 7 years. All patients received personalized chemotherapy followed by radiation and resection. For most patients, resection included removing and reconstructing veins and/or arteries ensnared by pancreatic tumors.

Study Findings

An average survival time of 58.8 months was achieved. Researchers found that patients with the following three factors had significantly longer survival times than those who did not:

  • Extended duration of chemotherapy before surgery
  • A CA 19-9 tumor marker that fell to a normal level after chemotherapy
  • Major pathologic response.

“We now have more advanced surgical techniques and more effective chemotherapy and radiation therapy. We can take all of these advances and put them together to get the outcomes we are looking for,” said lead study author Mark Truty, MD, an oncologic surgeon at the Mayo Clinic in Rochester, Minnesota. “The goal is to extend patients’ lives and maintain or improve their quality of life.”

Because the three factors were all related to response to chemotherapy, it may be possible to help many more patients with pancreatic cancer achieve them by adjusting their chemotherapy before surgery, Dr. Truty said.

About 29% of the patients had all 3 factors identified in the study; their median survival time has not yet been calculated because more than half are still alive. An additional 29% had 2 factors; their median survival was 58.6 months. About 31% had 1 factor and a median survival of 29.7 months; 11% had none of the factors, and their median survival was 18.5 months.

Just as important as identifying who is a good candidate for surgery is pinpointing who is a poor candidate, Dr. Truty said. The operation is more complex than surgery in patients whose cancer has not spread beyond the pancreas, and the risks must be weighed against the predicted benefit. 

Disclosure: The study authors’ full disclosures can be found at insights.ovid.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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