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Surgical Resection Among Patients Receiving Primary Chemotherapy for Borderline Resectable and Locally Advanced Pancreatic Cancer

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Key Points

  • Surgical resection was performed in 24.1% of patients with initial borderline resectable disease and 9.0% of those with initial locally advanced disease.
  • Among patients undergoing resection, median overall survival was 35.4 months for those with initial borderline resectable disease and 41.8 months for those with initial locally advanced disease.

In an Italian prospective cohort study reported in JAMA Surgery, Maggino et al found that among patients receiving primary chemotherapy for newly diagnosed pancreatic ductal adenocarcinoma, conversion to surgical resection was achieved in 24% of those with borderline resectable disease and 9% of those with locally advanced disease.

The study included 680 consecutive patients with borderline resectable (n = 267) or locally advanced (n = 413) pancreatic ductal adenocarcinoma enrolled at the time of diagnosis in a national referral center for pancreatic diseases between January 2013 and December 2015. Patients were followed up through June 2018. A total of 66 patients (9.7%) were lost to follow-up.

Chemotherapy and Surgical Resection

Primary chemotherapy was initiated in 570 patients (92.9%); the most common regimens were FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan; 45.6%) and gemcitabine plus nab-paclitaxel (21.6%). Death occurred within 6 months in 19 patients receiving chemotherapy (3.3%), primarily due to disease progression. Chemotherapy was completed in 71.6% of patients.

Surgical resection was performed in 93 (15.1%) of the 614 patients with follow-up, including 60 (24.1%) of 249 with initial borderline resectable disease and 33 (9.0%) of 365 with initial locally advanced disease. Factors independently associated with receipt of resection were age 75 years or younger, borderline resectable disease, chemotherapy completion, radiologic response, and biochemical response.

Median overall survival for the entire cohort was 12.8 months. Factors independently associated with improved survival were chemotherapy completion, receipt of complementary radiation therapy, and surgical resection. Among patients undergoing resection, median overall survival was 35.4 months for those with initial borderline resectable disease and 41.8 months for those with initial locally advanced disease.

The investigators concluded, “This pragmatic observational cohort study with an intention-to-treat design provides real-world evidence of outcomes associated with the most current primary chemotherapy regimens used for borderline resectable and locally advanced pancreatic ductal adenocarcinoma.”

Roberto Salvia, MD, PhD, and Giuseppe Malleo, MD, PhD, of the Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, are the corresponding authors for the JAMA Surgery article.

Disclosure: The study was supported by grants from the Associazione Italiana per la Ricerca sul Cancro, Italian Ministry of Health, and FP7 European Community Grant Cam-Pac. For full disclosures of the study authors, visit jamanetwork.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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