Locally advanced pancreatic cancer: neoadjuvant therapy with FOLFIRINOX results in resectability in 2/3 of the patients

Hackert, Thilo; Sachsenmaier, M; Hinz, Ulf; Schneider, Lutz; Michalski, Christoph; Springfeld, Christoph; Strobel, Oliver; Jäger, Dirk; Ulrich, Alexis; Büchler, Markus W.

doi:10.1016/j.pan.2016.05.263

Cited by 169 publications

(316 citation statements)

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“…These local invasive factors could have caused tumor exposure during operative manipulations. FOL-FIRINOX was especially effective for locally advanced pancreatic cancer (LAPC) and improving tumor shrinkage [5,25]. Based on these findings, we surmised that the operative procedure itself is responsible for cancer cell exposure, then dissemination, leading to PR.…”

Section: Discussionmentioning

confidence: 97%

Predictive risk factors for peritoneal recurrence after pancreatic cancer resection and strategies for its prevention

et al. 2017

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Section: Discussionmentioning

confidence: 97%

Predictive risk factors for peritoneal recurrence after pancreatic cancer resection and strategies for its prevention

et al. 2017

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“…The evidence for platinum therapy in PDAC is ever increasing in the neoadjuvant, adjuvant and palliative settings (42)(43)(44)(45)(46)(47). Exceptional responders to platinum therapy are well documented, yet biomarkers of response require testing in prospective clinical trials (9,39).…”

Section: Targeting Ddr Deficiencymentioning

confidence: 99%

Pancreatic Cancer Genomes: Implications for Clinical Management and Therapeutic Development

Dreyer

Chang

Bailey

et al. 2017

Clinical Cancer Research

144

114

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Pancreatic cancer has become the 3 rd leading cause of cancer death, with little improvement in outcomes despite decades of research. Surgery remains the only chance of cure, yet, only 20% will be alive at 5 years after pancreatic resection. Few chemotherapeutics provide any improvement in outcome, and even then, for approved therapies, the survival benefits are marginal. Genomic sequencing studies of pancreatic cancer have revealed a small set of consistent mutations found in most pancreatic cancers, and beyond that a low prevalence for targetable mutations. This may explain the failure of conventional clinical trial designs to show any meaningful survival benefit, except in small and undefined patient sub-groups. With the development of next generation sequencing technology, genomic sequencing and analysis can be performed in a clinically meaningful turnaround time. This can identify therapeutic targets in individual patients and personalize treatment selection.Incorporating pre-clinical discovery and molecularly guided therapy into clinical trial design has the potential to significantly improve outcomes in this lethal malignancy. In this review, we discuss the findings of recent large scale genomic sequencing projects in pancreatic cancer and the potential relevance of these data to therapeutic development.3

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“…However, comparable to the borderline situation, the optimal treatment regimen for locally advanced pancreatic cancer is still discussed controversially and current guidelines are not consistent in terms of regarding this finding as a palliative situation or a situation where neoadjuvant therapy followed by resection should be attempted. Neoadjuvant therapy in patients with locally advanced unresectable pancreatic cancer has gained increasing debates in recent years [20][21][22][23][24][25][26][27][28] . Sometimes, neoadjuvant chemotherapy with or without radiation might allow a regression of the malignant tumor, and it might even be able to convert an unresectable status to a resectable one [24] .…”

Section: Treatment Options For Borderline Resectable and Locally Advamentioning

confidence: 99%

“…It can achieve significantly higher secondary resection rates compared to other chemotherapeutics and finally leads to a better long-term survival. It should be considered in all patients fit for this regimen and consecutive surgical exploration [28] . Chemotherapy alone without intention to secondary surgical exploration may help some people living longer, but must be considered as palliative treatment option as it rarely results in longterm survival [29] .…”

Section: Treatment Options For Borderline Resectable and Locally Advamentioning

confidence: 99%

Extended Pancreatectomy: Does It Have a Role in the Contemporary Management of Pancreatic Adenocarcinoma?

Kaiser¹,

Hackert²,

Büchler³

2017

Dig Surg

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Background: Pancreatic cancer is a low-incident but highly mortal disease. Surgery is still the preferred treatment option for resectable pancreatic cancer as it offers the only realistic chance for cure. As many patients present with locally advanced disease, which is generally considered as not amenable to surgical treatment, it is important to know the limits of surgical therapy in this disease. Methods: In this review, the indication and outcomes of extended pancreatectomies as well as the alternative treatment options for locally advanced pancreatic cancer are described. Furthermore, controversies as well as ongoing and future directions for the treatment options of locally advanced pancreatic cancer are discussed. Results: Extended pancreatectomy can be performed with higher morbidity and mortality rates in patients with locally advanced pancreatic cancer compared to patients undergoing formal pancreatic resections. These procedures offer significant advantages with respect to both perioperative results and to long-term outcome when compared to chemotherapy. Conclusion: Due to the higher morbidity and mortality rates, these operations should be limited to specialist units with great experience in pancreatic surgery as well as experience in peri- and post-operative management of patients with pancreatic diseases.

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Locally advanced pancreatic cancer: neoadjuvant therapy with FOLFIRINOX results in resectability in 2/3 of the patients

Cited by 169 publications

References 0 publications

Predictive risk factors for peritoneal recurrence after pancreatic cancer resection and strategies for its prevention

Predictive risk factors for peritoneal recurrence after pancreatic cancer resection and strategies for its prevention

Pancreatic Cancer Genomes: Implications for Clinical Management and Therapeutic Development

Extended Pancreatectomy: Does It Have a Role in the Contemporary Management of Pancreatic Adenocarcinoma?

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