Use and outcomes from neoadjuvant chemotherapy in borderline resectable pancreatic ductal adenocarcinoma in an Australasian population

• Published in: Asia-Pacific journal of clinical oncology 2023-02, Vol.19 (1), p.214-225
• Main Authors: Walpole, Imogen, Lee, Belinda, Shapiro, Jeremy, Thomson, Benjamin, Lipton, Lara, Ananda, Sumitra, Usatoff, Val, Mclachlan, Sue‐Ann, Knowles, Brett, Fox, Adrian, Wong, Rachel, Cooray, Prasad, Burge, Matthew, Clarke, Kate, Pattison, Sharon, Nikfarjam, Mehrdad, Tebbutt, Niall, Harris, Marion, Nagrial, Adnan, Zielinski, Rob, Chee, Cheng Ean, Gibbs, Peter
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Cancer therapies; Carcinoma, Pancreatic Ductal - drug therapy; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Chemotherapy; Clinical trials; Deoxycytidine; drug therapy; Fluorouracil; Gemcitabine; general surgery; Humans; Irinotecan; Leucovorin; Middle Aged; mortality; neoadjuvant therapy; Neoadjuvant Therapy - methods; Oxaliplatin; Paclitaxel; Pancreatic cancer; Pancreatic Neoplasms; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Patients; Retrospective Studies; Surgery; Survival
• ISSN: 1743-7555; 1743-7563
• DOI: 10.1111/ajco.13807

Background Use of neoadjuvant (NA) chemotherapy is recommended when pancreatic ductal adenocarcinoma (PDAC) is borderline resectable Method A retrospective analysis of consecutive patients with localized PDAC between January 2016 and March 2019 within the Australasian Pancreatic Cancer Registry (PURPLE, Pancreatic cancer: Understanding Routine Practice and Lifting End results) was performed. Clinicopathological characteristics, treatment, and outcome were analyzed. Overall survival (OS) comparison was performed using log‐rank model and Kaplan–Meier analysis. Results The PURPLE database included 754 cases with localised PDAC, including 148 (20%) cases with borderline resectable pancreatic cancer (BRPC). Of the 148 BRPC patients, 44 (30%) underwent immediate surgery, 80 (54%) received NA chemotherapy, and 24 (16%) were inoperable. The median age of NA therapy patients was 63 years and FOLFIRINOX (53%) was more often used as NA therapy than gemcitabine/nab‐paclitaxel (31%). Patients who received FOLFIRINOX were younger than those who received gemcitabine/nab‐paclitaxel (60 years vs. 67 years, p = .01). Surgery was performed in 54% (43 of 80) of BRPC patients receiving NA chemotherapy, with 53% (16 of 30) achieving R0 resections. BRPC patients undergoing surgery had a median OS of 30 months, and 38% (9 of 24) achieved R0 resection. NA chemotherapy patients had a median OS of 20 months, improving to 24 months versus 10 months for patients receiving FOLFIRINOX compared to gemcitabine/nab‐paclitaxel (Hazard Ratio (HR) .3, p