Neoadjuvant gemcitabine and nab‐paclitaxel for borderline resectable pancreatic cancers: Intention‐to‐treat analysis compared with upfront surgery

Inoue, Yosuke; Saiura, Akio; Oba, Atsushi; Y, Ono; Mise, Yoshihiro; Ito, Hiromichi; Sasaki, Takashi; Ozaka, Masato; Sasahira, Naoki; Takahashi, Yu

doi:10.1002/jhbp.844

Cited by 39 publications

(42 citation statements)

References 40 publications

(92 reference statements)

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“…We thank Dr. Jonas and colleagues for their insightful comments and suggestions on our article. 1 Based on the findings in our article, and the results of their network meta-analysis published recently, 2 Dr. Jonas and colleagues hypothesized neoadjuvant therapy (NAT) would be beneficial for all nonmetastatic pancreatic cancer (PC) regardless of tumor extent, and proposed a further study to determine whether NAT can improve the long-term outcomes for patients with resectable PC (RPC) compared to the traditional upfront resection (UFR) approach. Although we agreed with their comments in terms of the need for a study to test the efficacy of NAT for RPC, we would like to pose some cautions for NAT approach for this group of patients.…”

Section: Anatomical Classification Alone Is Not Sufficient For Optimamentioning

confidence: 85%

Anatomical classification alone is not sufficient for optimal patient selection for neoadjuvant therapy versus upfront resection

Inoue

Ito

Takahashi

2021

J Hepato Biliary Pancreat

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Section: Anatomical Classification Alone Is Not Sufficient For Optimamentioning

confidence: 85%

Anatomical classification alone is not sufficient for optimal patient selection for neoadjuvant therapy versus upfront resection

Inoue

Ito

Takahashi

2021

J Hepato Biliary Pancreat

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“…The incidence of Clavien-Dindo ! grade IIIa complications ranged from 11% to 14% in the NAC-GnP group and 15% to 18% in the upfront surgery group (24,25). In a phase I trial of NAC-GnP in patients with BRPC, 2 of 8 (25%) patients had grade !…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of Neoadjuvant Gemcitabine Plus Nab-paclitaxel in Patients with Borderline-resectable Pancreatic Cancer

et al. 2023

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Objectives Neoadjuvant therapy followed by radical resection improves the borderline-resectable pancreatic cancer (BRPC) prognosis; however, the optimal therapeutic regimen remains unclear. Gemcitabine plus nabpaclitaxel (GnP) showed a high anti-tumor effect in primary lesions in a prospective study for metastatic disease. However, evidence concerning its feasibility is still lacking in patients with BRPC. We therefore evaluated the tolerability of neoadjuvant GnP (NAC-GnP) for BRPC. Patients and MethodsThis single-center prospective study evaluated 10 patients with BRPC who were treated with two cycles of NAC-GnP. The primary endpoint was feasibility for NAC-GnP. Treatment feasibility was defined as a successful outcome in at least eight patients. Results Ten patients who had BRPC in contact with the celiac artery (n = 5), superior mesenteric artery (n = 3), or hepatic artery (n = 2) were enrolled. The median age was 75 (range, 40-82) years old. Grade 3 anorexia and grade 2 pneumonia occurred in one patient each, so treatment was feasible in eight patients. The median primary tumor reduction and response rates were 33% (range, 0%-68%) and 60%, respectively. Six of eight patients who had abnormal CA19-9 levels at the time of enrolment showed a decrease in CA19-9 levels, with a median decrease of 72%. Five patients underwent radical resection, including R0 resection in four. Postoperative grade IIIa Clavien-Dindo complications occurred in one patient (upper gastrointestinal bleeding and pancreatic fistula). Conclusion Two-cycle NAC-GnP is a feasible treatment for patients with BRPC. Further studies on NAC-GnP in patients with BRPC are warranted.

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“…A multicenter trial showed that neoadjuvant S-1 therapy in combination with radiotherapy followed by surgery achieved an R0 resection rate of 63%[ 24 ]. Inoue et al [ 25 ] reported that NAT with gemcitabine and nab-paclitaxel improved downstaging of the tumor and allowed patient selection. Anger et al [ 26 ] investigated the role of NAT in different types of borderline PDAC according to international consensus criteria.…”

Section: Nat For Borderline and Unresectable Pdacmentioning

confidence: 99%

Role of imaging in evaluating the response after neoadjuvant treatment for pancreatic ductal adenocarcinoma

Zhang¹,

Huang²,

Song³

2021

WJG

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Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy. Despite the development of multimodality treatments, including surgical resection, radiotherapy, and chemotherapy, the long-term prognosis of patients with PDAC remains poor. Recently, the introduction of neoadjuvant treatment (NAT) has made more patients amenable to surgery, increasing the possibility of R0 resection, treatment of occult micro-metastasis, and prolongation of overall survival. Imaging plays a vital role in tumor response evaluation after NAT. However, conventional imaging modalities such as multidetector computed tomography have limited roles in the assessment of tumor resectability after NAT for PDAC because of the similar appearance of tissue fibrosis and tumor infiltration. Perfusion computed tomography, using blood perfusion as a biomarker, provides added value in predicting the histopathologic response of PDAC to NAT by reflecting the changes in tumor matrix and fibrosis content. Other imaging technologies, including diffusion-weighted imaging of magnetic resonance imaging and positron emission tomography, can reveal the tumor response by monitoring the structural changes in tumor cells and functional metabolic changes in tumors after NAT. In addition, with the renewed interest in data acquisition and analysis, texture analysis and radiomics have shown potential for the early evaluation of the response to NAT, thus improving patient stratification to achieve accurate and intensive treatment. In this review, we briefly introduce the application and value of NAT in resectable and unresectable PDAC. We also summarize the role of imaging in evaluating the response to NAT for PDAC, as well as the advantages, limitations, and future development directions of current imaging techniques.

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Neoadjuvant gemcitabine and nab‐paclitaxel for borderline resectable pancreatic cancers: Intention‐to‐treat analysis compared with upfront surgery

Cited by 39 publications

References 40 publications

Anatomical classification alone is not sufficient for optimal patient selection for neoadjuvant therapy versus upfront resection

Anatomical classification alone is not sufficient for optimal patient selection for neoadjuvant therapy versus upfront resection

A Prospective Study of Neoadjuvant Gemcitabine Plus Nab-paclitaxel in Patients with Borderline-resectable Pancreatic Cancer

Role of imaging in evaluating the response after neoadjuvant treatment for pancreatic ductal adenocarcinoma

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