- An expert panel of surgeons, medical oncologists, and gastrointestinal oncologists have reviewed current evidence on management of locally advanced pancreatic cancer (LAPC) to provide recommendations that focus on induction chemotherapy to convert unresectable tumors to resectable tumors.
Why this matters
- Randomized controlled trials are lacking on the topic.
- Some retrospective and nonrandomized studies suggest efficacy of induction therapy in LAPC.
- Patients should be selected for induction therapy on a case-by-case basis, considering factors such as tumor location, arterial involvement, CA 19-9 levels, performance status, weight loss, and biochemical parameters.
- Newer combination regimens like nab-paclitaxel+gemcitabine or FOLFIRINOX are options for induction therapy. No prospective data are available to recommend one over the other.
- Patients should receive at most 6 cycles of induction chemotherapy, with regular assessment and restaging.
- Radiographic imaging is unreliable in selecting patients for resection after induction therapy. Patients with no radiologic evidence of disease progression may be considered for exploratory laparotomy.
- Induction therapy can increase risk for postsurgical complications.
- Adjuvant chemotherapy may be offered, as well as chemoradiotherapy in cases of R1 resection and positive lymph nodes, if the therapies were not offered preoperatively. Choice of adjuvant therapy should consider patient tolerability and response to induction therapy.