Pancreatic cancer: neoadjuvant GnP tied to higher R0 resection rate

  • Miyasaka Y & al.
  • Ann Surg Oncol
  • 13 Mar 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • In patients with borderline resectable pancreatic cancer, neoadjuvant therapy with gemcitabine plus nab-paclitaxel (GnP) is associated with a higher R0 resection rate and better OS than upfront surgery.

Why this matters

  • GnP neoadjuvant therapy was previously shown to reduce tumor size in nonresectable pancreatic cancer.

Study design

  • Retrospective analysis of 31 patients who underwent GnP neoadjuvant therapy and 26 patients who underwent upfront surgery.
  • Funding: Grants-in-Aid for Scientific Research.

Key results

  • Median number of GnP cycles, 3 (range, 1-10).
  • Median change in tumor size with GnP, −23.3% (range, −51.4% to 28.0%).
  • Surgery outcomes, GnP vs upfront surgery:
    • R0 surgery, 100% vs 77% (P=.0100).
    • Lymph node metastases present at surgery, 67% vs 88% (P=.0581).
    • Median operation time, 429 vs 509.5 minutes (P=.0068).
    • Surgery blood loss, 760 vs 1324 mL (P=.0115).
  • Intermediate outcomes, GnP vs upfront surgery:
    • Recurrence frequency, 33% vs 77%.
    • Median disease-free survival (DFS), 633 vs 170 days.
    • Median 2-year DFS, 35.6% vs 16.4% (P=.0018).
    • Median OS, 838 vs 373 days.
    • Median 2-year OS, 73.0% vs 25.0% (P=.0024).

Limitations

  • Retrospective analysis.
  • Small study population.
  • Study conducted in Japan.

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