Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort

Walma, Marieke S.; Brada, Lilly J H; Patuleia, Susana I S; Blomjous, J. G. A. M.; Bollen, Thomas L.; Bosscha, K.; Bruijnen, R.; Busch, Olivier R.; Creemers, Geert-Jan; Daams, Freek; Dam, Ronald M. van; Festen, Sebastiaan; Groot, Derk Jan de; Groot, Jan Willem de; Mohammad, Nadia Haj; Hermans, John J.; Hingh, Ignace H. J. T. de; Kerver, Emile D.; Leeuwen, Maarten S. van; Leij, Christiaan van der; Liem, Mike S L; Lienden, Krijn P. van; Los, Maartje; Meijer, Vincent E de; Meijerink, Martijn R.; Mekenkamp, L.; Nio, C. Yung; Patijn, Gijs A.; Polée, Marco B.; Pruijt, J.F.M.; Renken, Nomdo S.; Rombouts, Steffi; Schouten, Ton; Stommel, Martijn W J; Verweij, Maaike E; Vos‐Geelen, Judith de; Vries, Jan J. J. de; Vulink, Annelie; Wessels, Frank J.; Wilmink, Johanna W.; Santvoort, Hjalmar C. van; Besselink, Marc G.; Molenaar, I. Quintus

doi:10.1016/j.ejso.2020.11.137

Cited by 21 publications

(23 citation statements)

References 27 publications

(34 reference statements)

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“…The median progression-free survival (PFS) of patients with MPC receiving FOLFIRINOX or GnP as the first-line chemotherapy ranged from 5.5 to 6.4 months (4,5). The median PFS of patients with LAPC receiving FOLFIRINOX or GnP ranged from 7 to 8 months (11). Compared with the aforementioned previous studies (4,5,11), the median PFS in our study was 6.4 months; longer PFS and shorter PFS were defined as PFS ≥7 months and PFS <7 months, respectively.…”

Section: Definitionmentioning

confidence: 49%

“…The median PFS of patients with LAPC receiving FOLFIRINOX or GnP ranged from 7 to 8 months (11). Compared with the aforementioned previous studies (4,5,11), the median PFS in our study was 6.4 months; longer PFS and shorter PFS were defined as PFS ≥7 months and PFS <7 months, respectively. Disease progression was assessed using the Response Evaluation Criteria in Solid Tumors, version 1.1 (12).…”

Section: Definitionmentioning

confidence: 49%

See 1 more Smart Citation

Association between progression-free survival and metal stent patency in patients with advanced pancreatic cancer

Ahn¹,

Ahn²,

Park³

et al. 2022

J Gastrointest Oncol

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Background: Chemotherapy reportedly affects the patency of self-expandable metal stents (SEMSs) in patients with cancer. However, knowledge regarding the association between SEMS patency and progression-free survival (PFS) remains limited. This study aimed to assess PFS and SEMS patency in patients with advanced pancreatic cancer.Methods: Between January 2012 and June 2021, 74 patients with locally advanced or metastatic pancreatic cancer (MPC) were enrolled in the study. Patients received gemcitabine plus nab-paclitaxel (GnP) or fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX) as initial chemotherapy and SEMS within 1 month before or after the initial chemotherapy. Longer PFS was defined as PFS ≥7 months.Results: This study enrolled 38 male patients (51.4%); the mean age was 66.2 [95% confidence interval (CI), 63.7-68.6] years. Of the patients, 46 (62.2%) had MPC and 58 (78.4%) received FOLFIRINOX as the initial chemotherapy. Of the patients, 61 (82.4%) underwent endoscopic SEMS insertion. The median stent patency and PFS were 6.9 [interquartile range (IQR), 4.5-12.9] and 6.4 (IQR, 4.2-12.5) months, respectively; the median overall survival (OS) was 10.5 (IQR, 6.7-16.5) months. Of the clinical parameters assessed using multivariate analysis, shorter PFS [PFS <7 months; hazard ratio (HR), 2.117; 95% CI, 1.020-4.393; P=0.044] and metastatic cancer (HR, 2.414; 95% CI, 1.159-5.018; P=0.019) were found to be associated with shorter SEMS patency. The median SEMS patency in patients with longer PFS and those with shorter PFS was 14.3 and 7.0 months (P=0.012), respectively, and that in patients with locally advanced cancer and those with metastatic cancer was 16.7 and 7.0 months (P=0.006), respectively. The coefficient of determination between stent patency and PFS was 0.624.Conclusions: SEMS patency may be associated with PFS in patients with advanced pancreatic cancer who receive GnP or FOLFIRINOX.

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Section: Definitionmentioning

confidence: 49%

Section: Definitionmentioning

confidence: 49%

Association between progression-free survival and metal stent patency in patients with advanced pancreatic cancer

Ahn¹,

Ahn²,

Park³

et al. 2022

J Gastrointest Oncol

View full text Add to dashboard Cite

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“…A recent observational study including 680 consecutive patients with borderline resectable and LAPC showed a median overall survival of 13 months for all patients after an intention-to-treat analysis [45]. Recent multicenter data from The Netherlands showed a median overall survival of 14 months for patients with LAPC treated with FOLFIRI-NOX [46]. These studies likely better reflect "real-world" data, and the assumption of 14.1 months can be preserved with these data.…”

Section: Discussionmentioning

confidence: 97%

Radiofrequency ablation and chemotherapy versus chemotherapy alone for locally advanced pancreatic cancer (PELICAN): study protocol for a randomized controlled trial

Walma

Rombouts

Brada

et al. 2021

Trials

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Background Approximately 80% of patients with locally advanced pancreatic cancer (LAPC) are treated with chemotherapy, of whom approximately 10% undergo a resection. Cohort studies investigating local tumor ablation with radiofrequency ablation (RFA) have reported a promising overall survival of 26–34 months when given in a multimodal setting. However, randomized controlled trials (RCTs) investigating the effect of RFA in combination with chemotherapy in patients with LAPC are lacking. Methods The “Pancreatic Locally Advanced Unresectable Cancer Ablation” (PELICAN) trial is an international multicenter superiority RCT, initiated by the Dutch Pancreatic Cancer Group (DPCG). All patients with LAPC according to DPCG criteria, who start with FOLFIRINOX or (nab-paclitaxel/)gemcitabine, are screened for eligibility. Restaging is performed after completion of four cycles of FOLFIRINOX or two cycles of (nab-paclitaxel/)gemcitabine (i.e., 2 months of treatment), and the results are assessed within a nationwide online expert panel. Eligible patients with RECIST stable disease or objective response, in whom resection is not feasible, are randomized to RFA followed by chemotherapy or chemotherapy alone. In total, 228 patients will be included in 16 centers in The Netherlands and four other European centers. The primary endpoint is overall survival. Secondary endpoints include progression-free survival, RECIST response, CA 19.9 and CEA response, toxicity, quality of life, pain, costs, and immunomodulatory effects of RFA. Discussion The PELICAN RCT aims to assess whether the combination of chemotherapy and RFA improves the overall survival when compared to chemotherapy alone, in patients with LAPC with no progression of disease following 2 months of systemic treatment. Trial registration Dutch Trial RegistryNL4997. Registered on December 29, 2015. ClinicalTrials.govNCT03690323. Retrospectively registered on October 1, 2018

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“…The prognosis of patients with inoperable pancreatic ductal adenocarcinoma (PDAC) is dismal despite substantial efforts to meaningfully improve outcomes (1). Over the last decade, modest gains have been realized by intensifying chemotherapy although long-term local control (LC) and overall survival (OS) are rarely achieved (2)(3)(4). Conversely, significantly escalating radiation therapy (RT) to an ablative dose has not been considered feasible for most patients using conventional image guidance because of interfraction anatomic changes and uncertainty in assuring that dose to nearby organs at risk (OARs) is safe prior to delivering each fraction (5).…”

Section: Introductionmentioning

confidence: 99%

Induction Chemotherapy and Ablative Stereotactic Magnetic Resonance Image-Guided Adaptive Radiation Therapy for Inoperable Pancreas Cancer

et al. 2022

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BackgroundRadiation therapy (RT) dose for inoperable pancreatic ductal adenocarcinoma (PDAC) has historically been non-ablative to avoid injuring gastrointestinal (GI) organs at risk (OARs). Accruing data suggest that dose escalation, in select patients, may significantly improve clinical outcomes. Early results of ablative stereotactic magnetic resonance image-guided adaptive radiation therapy (A-SMART) have been encouraging, although long-term outcomes are not well understood.MethodsA single institution retrospective analysis was performed of inoperable non-metastatic PDAC patients who received induction chemotherapy then 5-fraction A-SMART on a 0.35T-MR Linac from 2018-2021.ResultsSixty-two patients were evaluated with a median age of 66 years (range 35-91) and nearly all achieved Eastern Cooperative Oncology Group (ECOG) performance status 0-1 (96.8%). Locally advanced disease was common (72.6%), otherwise borderline resectable (22.6%), or medically inoperable (4.8%). All received induction chemotherapy for a median 4.2 months (range, 0.2-13.3) most commonly FOLFIRINOX (n=43; 69.4%). Median prescribed dose was 50 Gy (range 40-50); median biologically effective dose (BED10) was 100 Gy10. The median local control (LC), progression-free survival (PFS), and overall survival (OS) from diagnosis were not reached, 20 months, and 23 months, respectively. Also, 2-year LC, PFS, and OS were 68.8%, 40.0%, and 45.5%, respectively. Acute and late grade 3+ toxicity rates were 4.8% and 4.8%, respectively.ConclusionsTo our knowledge, this is the largest series of induction chemotherapy followed by ablative 5-fraction SMART delivered on an MR Linac for inoperable PDAC. The potential for this novel treatment strategy is to achieve long-term LC and OS, compared to chemotherapy alone, and warrants prospective evaluation.

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Treatment strategies and clinical outcomes in consecutive patients with locally advanced pancreatic cancer: A multicenter prospective cohort

Cited by 21 publications

References 27 publications

Association between progression-free survival and metal stent patency in patients with advanced pancreatic cancer

Association between progression-free survival and metal stent patency in patients with advanced pancreatic cancer

Radiofrequency ablation and chemotherapy versus chemotherapy alone for locally advanced pancreatic cancer (PELICAN): study protocol for a randomized controlled trial

Induction Chemotherapy and Ablative Stereotactic Magnetic Resonance Image-Guided Adaptive Radiation Therapy for Inoperable Pancreas Cancer

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