An evaluation of adjuvant chemotherapy following neoadjuvant chemotherapy and resection for borderline resectable and locally advanced pancreatic cancer

Zhang, Chunmeng; Wu, Ruiqian; Smith, Lynette M.; Baine, Michael J.; Lin, Chi; Reames, Bradley N.

doi:10.1016/j.amjsurg.2021.12.018

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…Other studies have also shown an advantage to adjuvant chemoradiation over observation after resection 54 . However, Zhang et al reported that adjuvant therapy did not demonstrate a significant association with survival in patients who underwent NAT followed by surgical resection, except for those with positive margins 55 . Further substantiated evidence is necessary to validate the efficacy of adjuvant therapy in advanced pancreatic cancer.…”

Section: Discussionmentioning

confidence: 98%

Perioperative and long-term survival outcomes of pancreatectomy with arterial resection in borderline resectable or locally advanced pancreatic cancer following neoadjuvant therapy: a systematic review and meta-analysis

Xue,

Huang,

Zhao

et al. 2023

International Journal of Surgery

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Background: Pancreatic cancer frequently involves the surrounding major arteries, preventing surgeons from making a radical excision. Neoadjuvant therapy (NAT) can lessen the size of local tumors and eliminate potential micrommetastases. However, systematic and evidence-based recommendations for the treatment of arterial resection (AR) after NAT in pancreatic cancer are scarce. Method: A computerized search of the Medline, Embase, Cochrane Library databases, and Clinicaltrials was performed to identify studies reporting the outcomes of patients who underwent pancreatectomy with AR and NAT for pancreatic cancer. Studies that reported perioperative and/or long-term results after pancreatectomy with AR and NAT were eligible for inclusion. The quality of the evidence was assessed with Newcastle–Ottawa Quality Assessment Form of bias tool. Data were pooled and analyzed by Stata 14.0 software. Result: Nine studies with an overall sample size of 215 met our eligibility criteria and were included in the meta-analysis. All studies were retrospective studies, and the methodological quality was moderate. The pooled morbidity and mortality rates were 51% (95% CI: 41–61%; I²= 0.0%) and 2% (95% CI: 0–0.08; I²=33.3%), respectively. Meta-analysis showed that the overall R0 resection rate was 79% (CI: 70–86%, I²=15.5%). Comparative data on R0 rates of patients who underwent pancreatectomy with and without NAT showed a significant difference in favor of the former group with moderate statistical heterogeneity (Relative risk=1.21; 95% CI: 0.776–1.915; I²=48.0%). The median 1-, 2-, 3-, and 5-year survival rates of patients who had AR were 92.3% (range: 72.7–100%), 64.8% (range: 25–78.8%), 51.6% (range: 16.7–63.6%), and 14% (range: 0–41.1%), respectively. Data on median progression-free survival ranged from 5.25 to 36.3 months, and the median overall survival ranged from 17 to 44.9 months. Conclusions: Pancreatectomy with major AR following NAT has the potential to enhance the survival rate of patients with unresectable pancreatic cancer involving the arteries by achieving R0 resection, despite a significant risk of postoperative complications. However, to validate the feasibility and effectiveness of this procedure, prospective controlled studies are necessary to address limitations arising from small sample sizes and potential biases inherent in retrospective studies.

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Section: Discussionmentioning

confidence: 98%

Perioperative and long-term survival outcomes of pancreatectomy with arterial resection in borderline resectable or locally advanced pancreatic cancer following neoadjuvant therapy: a systematic review and meta-analysis

Xue,

Huang,

Zhao

et al. 2023

International Journal of Surgery

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“…Another unsettled question is the role of adjuvant chemotherapy after neoadjuvant chemotherapy. Retrospective and population-based data suggest patients with poor prognostic factors, such as failure to normalize CA 19-9 levels, 170 positive surgical margins, 171 or positive lymph nodes, 172 might benefit from adjuvant chemotherapy. However, other studies suggest adjuvant chemotherapy might play a role after neoadjuvant therapy even for patients without poor prognostic features.…”

Section: Practical Aspects In the Management Of Potentially Resectabl...mentioning

confidence: 99%

Current Treatment of Potentially Resectable Pancreatic Ductal Adenocarcinoma: A Medical Oncologist’s Perspective

Jesus

Riechelmann

2023

Cancer Control

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Pancreatic cancer has traditionally been associated with a dismal prognosis, even in early stages of the disease. In recent years, the introduction of newer generation chemotherapy regimens in the adjuvant setting has improved the survival of patients treated with upfront resection. However, there are multiple theoretical advantages to deliver early systemic therapy in patients with localized pancreatic cancer. So far, the evidence supports the use of neoadjuvant therapy for patients with borderline resectable pancreatic cancer. The benefit of this treatment sequence for patients with resectable disease remains elusive. In this review, we summarize the data on adjuvant therapy for pancreatic cancer and describe which evidence backs the use of neoadjuvant therapy. Additionally, we address important issues faced in clinical practice when treating patients with localized pancreatic cancer.

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“…In an international multi-center retrospective study among patients who received neoadjuvant FOLFIRINOX and underwent surgical resection, adjuvant chemotherapy was associated with a higher overall survival only in patients who had node-positive disease on pathology evaluation [ 24 ]. Similarly, in a retrospective NCDB study that included patients with borderline resectable or locally advanced disease who were treated with neoadjuvant therapy, the addition of adjuvant therapy was associated with a survival benefit only among patients with positive margins after resection [ 25 ]. Among patients with stage I-II disease, another NCDB study found that adjuvant therapy after neoadjuvant therapy was associated with higher overall survival only among patients with low-risk pathologic features (i.e., low lymph node ratio, low-grade histology, and negative margin status) [ 26 ].…”

Section: Adjuvant Chemotherapymentioning

confidence: 99%

Advances and Remaining Challenges in the Treatment for Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma

Sulciner

Ashley

Molina

2022

JCM

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Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest malignancies in the United States. Improvements in imaging have permitted the categorization of patients according to radiologic involvement of surrounding vasculature, i.e., upfront resectable, borderline resectable, and locally advanced disease, and this, in turn, has influenced the sequence of chemotherapy, surgery, and radiation therapy. Though surgical resection remains the only curative treatment option, recent studies have shown improved overall survival with neoadjuvant chemotherapy, especially among patients with borderline resectable/locally advanced disease. The role of radiologic imaging after neoadjuvant therapy and the potential benefit of adjuvant therapy for borderline resectable and locally advanced disease remain areas of ongoing investigation. The advances made in the treatment of patients with borderline resectable/locally advanced disease are promising, yet disparities in access to cancer care persist. This review highlights the significant advances that have been made in the treatment of borderline resectable and locally advanced PDAC, while also calling attention to the remaining challenges.

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An evaluation of adjuvant chemotherapy following neoadjuvant chemotherapy and resection for borderline resectable and locally advanced pancreatic cancer

Cited by 4 publications

References 26 publications

Perioperative and long-term survival outcomes of pancreatectomy with arterial resection in borderline resectable or locally advanced pancreatic cancer following neoadjuvant therapy: a systematic review and meta-analysis

Perioperative and long-term survival outcomes of pancreatectomy with arterial resection in borderline resectable or locally advanced pancreatic cancer following neoadjuvant therapy: a systematic review and meta-analysis

Current Treatment of Potentially Resectable Pancreatic Ductal Adenocarcinoma: A Medical Oncologist’s Perspective

Advances and Remaining Challenges in the Treatment for Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma

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