Neoadjuvant Treatment in Patients With Resectable and Borderline Resectable Pancreatic Cancer

Janssen, Quisette P.; O’Reilly, Eileen M.; Eijck, Casper H.J. van; Koerkamp, Bas Groot

doi:10.3389/fonc.2020.00041

Cited by 66 publications

(57 citation statements)

References 61 publications

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“…2) Complications in endoscopy [30][31][32]: -haemorrhage (0.96%) -pancreatitis (0.19%) -perforation (0.09%) -infection (0.4-1%) -hyperamylasemia (4.7%, 3 hours after the procedure) 3) Risk of progression during neoadjuvant therapy Table 3. Neoadjuvant trials, edited according to Janssen et al [45] and Piatek et al [46] Study author…”

Section: Discussionmentioning

confidence: 99%

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Current view of neoadjuvant chemotherapy in primarily resectable pancreatic adenocarcinoma

Eid¹,

Ostřížková²,

Kunovský³

et al. 2021

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Pancreatic ductal adenocarcinoma (PDAC) is now the 11th most common cancer and in 2018 there were 458,918 new cases worldwide. In the Czech Republic, a total of 2,173 patients were diagnosed in 2015, ranking the second in incidence worldwide. In contrast to other malignancies, recent research has not brought any major breakthrough in the treatment of PDAC and hence the prognosis remains very serious. Radical resection is the only curative approach, but after the initiation of the standard pathological evaluation of the resected tissue, according to the Leeds protocol, 80% of the resections are R1 (resections with microscopically positive margins). The results of studies in patients with borderline resectable or locally advanced PDAC prefer neoadjuvant chemotherapy or chemoradiotherapy. This approach leads to a higher number of radical R0 resections and better survival. For neoadjuvant treatment in patients with primarily resectable PDAC, most results come from retrospective analysis or phase II trials. However, recently, data from three randomized clinical trials with neoadjuvant therapy for resectable PDAC were presented. These results support the use of chemotherapy or chemoradiotherapy prior to surgery. In the trials published to date, there are differences in chemotherapeutic regimens, cytostatic doses, and the definition of resectability. Thus, up-front resection with adjuvant chemotherapy is still the standard of care and a well-designed randomized trial using neoadjuvant therapy is now necessary.

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Section: Discussionmentioning

confidence: 99%

“…This study has completed accrual and randomized 147 patients to 3 cycles of either perioperative mFOLFIRINOX (arm A) or perioperative gemcitabine with nab-paclitaxel (arm B). The primary endpoint of study is OS at 2 years, and results are anticipated to 2020 [45].…”

mentioning

confidence: 99%

Current view of neoadjuvant chemotherapy in primarily resectable pancreatic adenocarcinoma

Eid¹,

Ostřížková²,

Kunovský³

et al. 2021

neo

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“…3 However, the interval between neoadjuvant therapy and PD for patients with pancreatic cancer did not impact short-term morbidity or mortality.…”

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confidence: 94%

“…Although surgical extirpation offers the greatest opportunity for cure, only 10–20% of patients have resectable disease at the time of diagnosis. 3 , 4 In patients with borderline resectable or locally advanced pancreatic cancer, neoadjuvant chemotherapy (NAC) is recommended to improve patient selection for operative resection. 5 , 6 Multiagent chemotherapy, including 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX) or gemcitabine with nab -paclitaxel, offers improvement in overall survival but can have harmful side effects including neurotoxicity and hepatotoxicity such as steatosis or steatohepatitis.…”

Section: Introductionmentioning

confidence: 99%

Hepatic Steatosis After Neoadjuvant Chemotherapy for Pancreatic Cancer: Incidence and Implications for Outcomes After Pancreatoduodenectomy

Flick

Al-Temimi

Maatman

et al. 2020

Journal of Gastrointestinal Surgery

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Background This study aimed to determine the incidence of new onset hepatic steatosis after neoadjuvant chemotherapy for pancreatic cancer and its impact on outcomes after pancreatoduodenectomy. Methods Retrospective review identified patients who received neoadjuvant chemotherapy for pancreatic adenocarcinoma and underwent pancreatoduodenectomy from 2013 to 2018. Preoperative computed tomography scans were evaluated for the development of hepatic steatosis after neoadjuvant chemotherapy. Hypoattenuation included liver attenuation greater than or equal to 10 Hounsfield units less than tissue density of spleen on noncontrast computed tomography and greater than or equal to 20 Hounsfield units less on contrast-enhanced computed tomography. Results One hundred forty-nine patients received neoadjuvant chemotherapy for a median of 5 cycles (interquartile range (IQR), 4-6). FOLFIRINOX was the regimen in 78% of patients. Hepatic steatosis developed in 36 (24%) patients. The median time from neoadjuvant chemotherapy completion to pancreatoduodenectomy was 40 days (IQR, 29-51). Preoperative biliary stenting was performed in 126 (86%) patients. Neoadjuvant radiotherapy was delivered to 23 (15%) patients. Female gender, obesity, and prolonged exposure to chemotherapy were identified as risk factors for chemotherapy-associated hepatic steatosis. Compared with control patients without neoadjuvant chemotherapy-associated hepatic steatosis, patients developing steatosis had similar rates of postoperative pancreatic fistula (8% (control) vs. 4%, p = 0.3), delayed gastric emptying (8% vs. 14%, p = 0.4), and major morbidity (11% vs. 15%, p = 0.6). Ninety-day mortality was similar between groups (8% vs. 2%, p = 0.08). Conclusion Hepatic steatosis developed in 24% of patients who received neoadjuvant chemotherapy but was not associated with increased morbidity or mortality after pancreatoduodenectomy.

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“…Although mortality rates following pancreatectomy are now less than 5% in high-volume tertiary referral centers, morbidity following pancreatectomy is still common with rates estimated as high as 40-50% [8,9]. Currently, oncological outcomes in patients with advanced PDAC have markedly improved with multimodal neoadjuvant treatment (NAT) followed by surgical resection and NAT followed by surgery was regard as the guideline treatment for patients with PDAC [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Neutrophil–lymphocyte ratio (NLR) was associated with prognosis and immunomodulatory in patients with pancreatic ductal adenocarcinoma (PDAC)

Xiang

Wang

et al. 2020

Bioscience Reports

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Although the oncological outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) have markedly improved over the past decade, the survival prediction is still challenging. The aim of this study was to investigate the prognostic value of neutrophil–lymphocyte ratio (NLR) and analyze the relationship of between the NLR and immune cells phenotypes in patients with PDAC. Sixty-seven consecutive patients with PDAC were recruited in this study. Life-table estimates of survival time were calculated according to the Kaplan and Meier methodology. The phenotypic T cells subclasses were evaluated by flow cytometry. All the 67 patients in this study were treated with surgical resection and among them, 46 patients received adjuvant chemotherapy. Receiver operating characteristic (ROC) curves analysis was performed to compare prognostic value of NLR with CA199. We found that the Harrell's area under ROC (AUROC) for the NLR to predict overall survival (OS) (0.840; 95% CI, 0.766–0.898) was significantly higher than that of the CA199 levels. After that we stratified all patients into NLR > 2.5 (n = 42) and NLR ≤ 2.5 (n = 25) groups according to the OS of patients with PDAC. Survival analysis showed that patients with NLR ≤ 2.5 had significantly favorable OS and progressive free survival (PFS) compared with patients with NLR > 2.5. The CD3+ and CD8+/CD28+ T cell subsets were significantly increased in patients with NLR ≤ 2.5 (P<0.05), while the CD8+/CD28- and CD4+/CD25+ cell subsets were significantly decreased in patients with NLR ≤ 2.5 (P<0.05). In conclusion, a high NLR value independently predicts poor survival in patients with PDAC after surgical resection. The NLR was closely related with immune cells phenotypes The NLR may help oncologists evaluate outcomes of patients received surgical resection and chemotherapy to choose alternative therapies for patients with high NLR value.

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Neoadjuvant Treatment in Patients With Resectable and Borderline Resectable Pancreatic Cancer

Cited by 66 publications

References 61 publications

Current view of neoadjuvant chemotherapy in primarily resectable pancreatic adenocarcinoma

Current view of neoadjuvant chemotherapy in primarily resectable pancreatic adenocarcinoma

Hepatic Steatosis After Neoadjuvant Chemotherapy for Pancreatic Cancer: Incidence and Implications for Outcomes After Pancreatoduodenectomy

Neutrophil–lymphocyte ratio (NLR) was associated with prognosis and immunomodulatory in patients with pancreatic ductal adenocarcinoma (PDAC)

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