Extended neoadjuvant chemotherapy (CT) in borderline resectable pancreatic cancer (BRPC): Updated results

• Published in: Journal of clinical oncology Vol. 35; no. 15_suppl; p. e15771
• Main Authors: Kanji, Zaheer S., Rocha, Flavio G, Edwards, Alicia M, Mandelson, Margaret T., Lin, Bruce S., Kozarek, Richard A., Rose, J. Bart B., Biehl, Thomas R, Alseidi, Adnan, Helton, Scott, Picozzi, Vincent J.
• Format: Journal Article
• Language: English
• Published: 20-05-2017
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2017.35.15_suppl.e15771

Abstract only
e15771
Background: Optimum therapy (Rx) for BRPC is unknown. Since 2008, we have used neoadjuvant Rx with extended course chemotherapy (CT) but not routine neoadjuvant chemoradiation (CRT). Initial results were presented in 2013 (Rose et.al. J Clin Oncolabstr 4043). We present updated findings here. Methods: Patients (pts) were prospectively identified in our institutional PC database. Inclusion criteria: 1) bx-proven PC; 2) radiographic staging per AHPBA/NCCN criteria; 3) no prior Rx; 4) negative staging laparoscopy whenever feasible; 5) all neoadjuvant Rx at our institution, 6) followup ≥ 24 weeks (wks) from initial Rx . Unless disease progression or Rx intolerance noted, pts received gemcitabine/docetaxel (G/D) as neoadjuvant CT x 24 weeks . At that time, all pts felt likely to achieve R0 resection offered surgery; other pts offered 5FU –based CRT if medically fit. Results evaluated by "intent to treat". Results: Among 129 pts, characteristics include median age 66 yrs (range 33-88 yrs), ECOG PS 0/1/2+ 86/36/7, 97%/43% venous /arterial involvement. 78% (101/129) pts completed ≥80% intended CT; 38% (6/16) pts age > 80 and /or ECOG 2+ (p < 0.01) 51% (66/129) pts were resected (44 R0, 22 R1 ≤ 1 mm margin ). 49% (63/129) pts were not (24 disease progression, 17 surgeon decision (anatomy/safety), 11 Rx toxicity/ comorbidity, 6 unresectable at surgery, 5 pt withdrawal). 45% (31/66) and 23% (16/66) resected pts received postop CRT/CT respectively. Median f/u is 47 months (mo). 58% (38/66) resected pts recurred: 18% (12/66) local, 41% (27/66) systemic. For resected pts, median PFS is 25.0 (95% CI: 16.2-32.7) mo, median OS is 37.6 (95% CI: 27.4-58.5) mo. 5-yr OS is 28% ( 95% CI :14-44%). Median OS for non-resected pts is 13.1 (95% CI 10.9-16.9) mo .Median OS for all pts is 22.1 (95% CI: 18.7-28.4) mo. Conclusions: 1.Our series is distinctive with respect to size, use of laparoscopic staging and neoadjuvant G/D CT as standards,and median f/u 2. Pt selection is key; e.g.approach suboptimal for pts > 80 yrs/ ECOG PS 2+ 3. Reported OS compares favorably with other BRPC and de novo resectable PC cooperative group results 4. Detailed analysis of our study (e.g. prognostic factors) will aid future clinical research in BRPC.