The Survival Benefit of Chemoradiotherapy following Induction Chemotherapy with Gemcitabine Plus Nab-Paclitaxel for Unresectable Locally Advanced Pancreatic Cancer

Abstract

An optimal therapeutic strategy for unresectable locally advanced pancreatic cancer (UR-LAPC) has not been established. This study investigated the therapeutic efficacy of chemoradiotherapy (CRT) following induction chemotherapy with gemcitabine plus nab-paclitaxel (GnP) (CRT group) compared with systemic chemotherapy alone (CTx group) in patients with UR-LAPC. This was a retrospective study of 63 consecutive patients with UR-LAPC treated at our department in a Japanese cancer referral center between February 2015 and July 2018. We excluded patients who underwent other regimens and those enrolled in another prospective study. The CRT group (n = 25) exhibited significantly better progression-free survival (PFS) and overall survival (OS) than the CTx group (n = 20, PFS 17.9 vs. 7.6 months, p = 0.044; OS 29.2 vs. 17.4 months, p < 0.001). In the multivariate analyses, CRT following induction chemotherapy was identified as an independent prognostic factor for OS. Seven (15.6%) patients underwent conversion surgery, all of whom were in the CRT group. The R0 resection rate was 85.7% (6/7). In summary, patients with UR-LAPC experienced favorable treatment outcomes after receiving GnP as the first-line chemotherapy, especially when receiving additional CRT. Thus, this treatment strategy represents a promising treatment option for selected patients with UR-LAPC.

Prognostic Impact of Positive Peritoneal Lavage Cytology on Resectable Pancreatic Body and Tail Cancer: A Retrospective Study

“…Gemcitabine plus nab-paclitaxel and FOLFIRINOX [a combination of drugs, including: FOL -folinic acid, Ffluorouracil, Irin -irinotecan, and Ox -oxaliplatin] has become the standard treatment for unresectable or recurrent pancreatic cancer. The median OS for these treatments is [42,43]. Neoadjuvant chemotherapy is being increasingly used in resectable pancreatic cancer [44].…”

“…On the other hand, locally advanced pancreatic cancer treated with chemotherapy or chemoradiotherapy alone with gemcitabine plus nab‐paclitaxel or FOLFIRINOX has shown improved outcomes, with survival ranging from 10.0 to 32.7 months. This prognosis is better than that for CY+ resected cases [42, 43]. Neoadjuvant chemotherapy is being increasingly used in resectable pancreatic cancer [44].…”

Main pancreatic duct dilatation and pancreatic cysts in relatives and spouses of patients with pancreatic cancer

“…Approximately 80% of patients with pancreatic cancer (PC) are diagnosed with metastatic or locally advanced disease [1]. Although recent progress in chemotherapy and chemoradiotherapy has improved prognosis to some extent, patients with PC still have a poor prognosis, with a 5-year overall survival rate of 9% [2][3][4][5]. Because it is difficult to detect PC at an early stage, surveillance with imaging modalities for the appropriate target is important [6][7][8][9].…”

Prognostic factors in conversion surgery following nab‐paclitaxel with gemcitabine and subsequent chemoradiotherapy for unresectable locally advanced pancreatic cancer: Results of a dual‐center study

“…However, little information is available on surgical outcomes or prognostic factors following this approach for UR‐LA PDAC, and compelling evidence, such as prognostic implications or concrete indications for resection, is lacking. A unique feature of the present study is that it evaluated the results of a single regimen, induction GnP and subsequent CRT, whereas many previous reports have analyzed a mixed cohort of chemotherapy alone and CRT cases 10–13 . Most surgeries for UR‐LA disease after long‐term induction therapy are highly invasive and technically demanding with combined multiple vascular resection; therefore, it is necessary to identify factors that contribute to long‐term prognosis in this therapeutic strategy.…”

“…A unique feature of the present study is that it evaluated the results of a single regimen, induction GnP and subsequent CRT, whereas many previous reports have analyzed a mixed cohort of chemotherapy alone and CRT cases. 10 , 11 , 12 , 13 Most surgeries for UR‐LA disease after long‐term induction therapy are highly invasive and technically demanding with combined multiple vascular resection; therefore, it is necessary to identify factors that contribute to long‐term prognosis in this therapeutic strategy.…”