Nab-paclitaxel plus gemcitabine in patients with locally advanced pancreatic cancer (LAPACT): a multicentre, open-label phase 2 study

Philip, Philip A.; Lacy, Jill; Portales, Fabienne; Sobrero, Alberto F.; Pazo-Cid, Roberto; Mozo, José Luis Manzano; Kim, Edward Jae-hoon; Dowden, Scot; Zakari, Ahmed; Borg, Christophe; Terrebonne, Éric; Rivera, Fernando; Sastre, Javier; Bathini, Venu; López-Trabada, Daniel; Asselah, Jamil; Saif, Muhammad Wasif; Li, Jack Shiansong; Ong, Teng Jin; Nydam, Thomas; Hammel, Pascal

doi:10.1016/s2468-1253(19)30327-9

Cited by 176 publications

(154 citation statements)

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“… 12 , 13 Although there is no data based on randomized phase III trials investigating BRPC or LAPC, the proven efficacy in metastatic pancreatic cancer has led to wide incorporation of these regimens in managing patients with BRPC or LAPC. 14 – 16 …”

Section: Introductionmentioning

confidence: 99%

FOLFIRINOX in borderline resectable and locally advanced unresectable pancreatic adenocarcinoma

et al. 2020

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Background: Despite the scarcity of data based on randomized trials, FOLFIRINOX is widely used in the management of borderline resectable pancreatic cancer (BRPC) and locally advanced unresectable pancreatic cancer (LAPC). We investigated the clinical outcomes of neoadjuvant FOLFIRINOX in patients with BRPC and LAPC. Methods: This single-center retrospective analysis included a total of 199 consecutive patients with BRPC or LAPC who received conventional or modified FOLFIRINOX between February 2013 and January 2017. An independent radiologist reviewed all baseline computed tomography or magnetic resonance imaging scans were reviewed for vascular invasion status. Results: With median follow-up duration of 40.3 months [95% confidence interval (CI), 36.7–43.8] in surviving patients, median progression-free survival (PFS) and overall survival (OS) were 10.6 (95% CI, 9.5–11.7) and 18.1 (95% CI, 16.0–20.3) months, respectively. The 1-year PFS rate was 66.0% (95% CI, 65.3–66.7%), and the 2-year OS rate was 37.2% (95% CI, 36.5–37.9%). PFS and OS did not differ between BRPC and LAPC groups [median PFS, 11.1 months (95% CI, 8.8–13.5) versus 10.1 months (95% CI, 8.4–11.8), p = 0.47; median OS, 18.4 months (95% CI, 16.1–20.8) versus 17.1 months (95% CI, 13.2–20.9), p = 0.50]. Curative-intent conversion surgery (R0/R1) was performed in 63 patients (31.7%). C•A 19-9 response, objective tumor response to FOLFIRINOX, and conversion surgery were independent prognostic factors for OS. Conclusion: FOLFIRINOX was effective for management of BRPC and LAPC. Given the potential for cure, a significant proportion of patients can undergo conversion curative-intent surgery following FOLFIRINOX.

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Section: Introductionmentioning

confidence: 99%

FOLFIRINOX in borderline resectable and locally advanced unresectable pancreatic adenocarcinoma

et al. 2020

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“…In a multicenter study, Philip et al. indicated that chemotherapy combined with surgical resection significantly improved the survival of LAPC patients with a median OS of 18.8 months, compared with those who received chemotherapy only ( 2 ). Additionally, Janet et al.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal treatment for LAPC remains an open research question, given the lack of prospective studies of the latest chemotherapy regimens. Although the development of chemotherapy provided survival benefit for LAPC, the survival of LAPC after chemotherapy was also unsatisfied ( 2 ). Additional studies are underway to further delineate the chemotherapy that provides more survival benefits.…”

Section: Introductionmentioning

confidence: 99%

Survival Comparison of Neoadjuvant Chemotherapy Followed by Irreversible Electroporation Versus Conversional Resection for Locally Advanced Pancreatic Cancer

Sun

Huang

et al. 2021

Front. Oncol.

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Locally advanced pancreatic cancer (LAPC) is a lethal disease and neoadjuvant chemotherapy and conversional resection is shown to provide the best survival for LAPC patients. Irreversible electroporation (IRE) is a new and effective method for the treatment of LAPC. This study aimed to compare the long-term survival of LAPC patients after neoadjuvant chemotherapy followed by conversional resection and IRE. A total of 140 LAPC patients were included from August 2015 to March 2020. The survival outcomes of patients after treatment with chemotherapy, chemotherapy combined with conversional resection or IRE were analyzed and compared. Patients in these three groups had similar clinical and pathological characteristics. Patients in the resection and IRE groups had similar median OS time (resection group vs. IRE group: 25.3 months vs. 26.0 months, P>0.050), which was significantly longer than that of the chemotherapy group (8.7 months, P<0.001). Additionally, patients in the resection and IRE groups had a median PFS of 10.6 and 12.0 months, respectively. Also, they were significantly higher than that of patients in the chemotherapy group. Chemotherapy combined with conversional resection and IRE was identified as significant prognostic factors for OS and PFS in LAPC patients. It was shown that compared with neoadjuvant chemotherapy followed by surgical resection, chemotherapy and IRE provided similar OS and PFS for LAPC patients with minimal invasion. This combination therapy may be a suitable treatment for LAPC patients.

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“…Toxicity was manageable and mainly hematological (grade 3 neutropenia, anemia and fatigue). There was no adjuvant chemotherapy following the induction strategy [ 33 ].…”

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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Nab-paclitaxel plus gemcitabine in patients with locally advanced pancreatic cancer (LAPACT): a multicentre, open-label phase 2 study

Cited by 176 publications

References 20 publications

FOLFIRINOX in borderline resectable and locally advanced unresectable pancreatic adenocarcinoma

FOLFIRINOX in borderline resectable and locally advanced unresectable pancreatic adenocarcinoma

Survival Comparison of Neoadjuvant Chemotherapy Followed by Irreversible Electroporation Versus Conversional Resection for Locally Advanced Pancreatic Cancer

Adjuvant Pancreatic Cancer Management: Towards New Perspectives in 2021

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