Evaluation of Adjuvant Chemotherapy in Patients With Resected Pancreatic Cancer After Neoadjuvant FOLFIRINOX Treatment

Roessel, Stijn van; Veldhuisen, Eran van; Klompmaker, Sjors; Janssen, Quisette P.; Hilal, Mohammed Abu; Alseidi, Adnan; Balduzzi, Alberto; Balzano, Gianpaolo; Bassi, Claudio; Berrevoet, Frederik; Bonds, Morgan; Busch, Olivier R.; Butturini, Giovanni; Chiaro, Marco Del; Conlon, Kevin C.; Falconi, Massimo; Frigerio, Isabella; Fusai, Giuseppe; Gagnière, Johan; Griffin, Oonagh; Hackert, Thilo; Halimi, Asif; Klaiber, Ulla; Labori, Knut Jørgen; Malleo, Giuseppe; Marino, Marco Vito; Mortensen, Michael Bau; Nikov, Andrej; Lesurtel, Mickaël; Keck, Tobias; Kleeff, Jörg; Pandé, Rupaly; Pfeiffer, Per; Pietrasz, Daniel; Roberts, Keith; Cunha, A. Sá; Salvia, Roberto; Strobel, Oliver; Tarvainen, Timo; Bossuyt, Patrick M.; Laarhoven, H.W.M. van; Wilmink, Johanna W.; Koerkamp, Bas Groot; Besselink, Marc G.

doi:10.1001/jamaoncol.2020.3537

Cited by 99 publications

(83 citation statements)

References 26 publications

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“…Neoadjuvant chemoradiation was associated with a 57% decreased odds of lymph node metastases as compared to chemotherapy alone 42 . In addition, we and others have observed that patients with node‐negative disease are less likely to benefit from any adjuvant therapy 43,44 . Further, neoadjuvant radiotherapy reduced the odds of local‐only recurrence by 79% compared to those who received neoadjuvant chemotherapy alone 30 .…”

Section: Future Challengesmentioning

confidence: 70%

Ten‐year experience in optimizing neoadjuvant therapy for localized pancreatic cancer—Medical college of Wisconsin perspective

Ward

Evans

Tsai

2021

Journal of Surgical Oncology

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Treatment of localized pancreatic cancer has also evolved to prioritize preoperative (neoadjuvant) multimodality therapy over a surgery‐first approach. Given the complexities of pancreatic cancer staging and the challenge of delivering multiple treatment modalities (chemotherapy, radiation therapy, and surgery), an experienced and highly integrated multidisciplinary team is necessary to achieve the best outcomes. In this review, we will discuss our institutional experience with neoadjuvant therapy, guiding principles for treatment, and outline the landscape for future investigations.

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Section: Future Challengesmentioning

confidence: 70%

Ten‐year experience in optimizing neoadjuvant therapy for localized pancreatic cancer—Medical college of Wisconsin perspective

Ward

Evans

Tsai

2021

Journal of Surgical Oncology

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“…The role of adjuvant therapy following neoadjuvant therapy and resection, however, is less clear. A recent multi-centre international study demonstrated that adjuvant chemotherapy following NAT, was only of benefit among patients with node positive disease [ 138 ].…”

Section: Post-operative Pathwaysmentioning

confidence: 99%

Achieving ‘Marginal Gains’ to Optimise Outcomes in Resectable Pancreatic Cancer

Powell‐Brett

Pandé

Roberts

2021

Cancers

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Improving outcomes among patients with resectable pancreatic cancer is one of the greatest challenges of modern medicine. Major improvements in survival will result from the development of novel therapies. However, optimising existing pathways, so that patients realise benefits of already proven treatments, presents a clear opportunity to improve outcomes in the short term. This narrative review will focus on treatments and interventions where there is a clear evidence base to improve outcomes in pancreatic cancer, and where there is also evidence of variation and under-treatment. Avoidance of preoperative biliary drainage, treatment of pancreatic exocrine insufficiency, prehabiliation and enhanced recovery after surgery, reducing perioperative complications, optimising opportunities for elderly patients to receive therapy, optimising adjuvant chemotherapy and regular surveillance after surgery are some of the strategies discussed. Each treatment or pathway change represents an opportunity for marginal gain. Accumulation of marginal gains can result in considerable benefit to patients. Given that these interventions already have evidence base, they can be realised quickly and economically.

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“…Adjuvant chemotherapy was only found to be beneficial on multivariate analysis, in patients with a positive lymph node status (median OS, 26 vs. 13 months; multivariate HR, 0.41 [95% CI, 0.22–0.75]; p = 0.004). It is important to note that there was no further advantage in patients who received ≥ 4 cycles of FOLFIRINOX induction [ 40 ]. It is not known whether patients had N0 status before induction treatment or if this was due to downstaging by chemotherapy.…”

Section: New Issuesmentioning

confidence: 99%

“…Interestingly, patients with a significant lymph node burden following neoadjuvant treatment did not benefit from adjuvant chemotherapy in that study [ 43 ]. In contrast, in three large retrospective studies, the benefit of adjuvant therapy in patients who had received neoadjuvant therapy was limited to those with pathological node-positive status [ 40 , 41 , 44 ]. Thus, prospective studies are needed to evaluate the role of adjuvant chemotherapy, particularly in pN0 patients.…”

Section: New Issuesmentioning

confidence: 99%

Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021

Turpin

Amrani

Bachet

et al. 2020

Cancers

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Adjuvant chemotherapy is currently used in all patients with resected pancreatic cancer who are able to begin treatment within 3 months after surgery. Since the recent publication of the PRODIGE 24 trial results, modified FOLFIRINOX has become the standard-of-care in the non-Asian population with localized pancreatic adenocarcinoma following surgery. Nevertheless, there is still a risk of toxicity, and feasibility may be limited in heavily pre-treated patients. In more frail patients, gemcitabine-based chemotherapy remains a suitable option, for example gemcitabine or 5FU in monotherapy. In Asia, although S1-based chemotherapy is the standard of care it is not readily available outside Asia and data are lacking in non-Asiatic patients. In patients in whom resection is not initially possible, intensified schemes such as FOLFIRINOX or gemcitabine-nabpaclitaxel have been confirmed as options to enhance the response rate and resectability, promoting research in adjuvant therapy. In particular, should oncologists prescribe adjuvant treatment after a long sequence of chemotherapy +/– chemoradiotherapy and surgery? Should oncologists consider the response rate, the R0 resection rate alone, or the initial chemotherapy regimen? And finally, should they take into consideration the duration of the entire sequence, or the presence of limited toxicities of induction treatment? The aim of this review is to summarize adjuvant management of resected pancreatic cancer and to raise current and future concerns, especially the need for biomarkers and the best holistic care for patients.

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Evaluation of Adjuvant Chemotherapy in Patients With Resected Pancreatic Cancer After Neoadjuvant FOLFIRINOX Treatment

Cited by 99 publications

References 26 publications

Ten‐year experience in optimizing neoadjuvant therapy for localized pancreatic cancer—Medical college of Wisconsin perspective

Ten‐year experience in optimizing neoadjuvant therapy for localized pancreatic cancer—Medical college of Wisconsin perspective

Achieving ‘Marginal Gains’ to Optimise Outcomes in Resectable Pancreatic Cancer

Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021

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