Analyses for clinical outcomes of GS and GnP neoadjuvant therapies followed by surgery for borderline resectable pancreatic cancer

Abstract

To improve the prognosis of pancreatic ductal adenocarcinoma (PDAC) patients, curative resection with multidisciplinary therapy is needed. Consecutive 116 patients with borderline resectable (BR) PDAC who undergone pancreatectomy from Jan 2008 to Dec 2018 were analyzed. We assessed the clinical significance of neoadjuvant therapy (NAT), and compared the clinical impact between gemcitabine plus S-1 (GS) and gemcitabine plus nab-paclitaxel (GnP) for neoadjuvant chemotherapy (NAC) in BR PDAC (n=62). Comparing between surgery first (SF: n=45) and NAT (n=71) group, the Kaplan-Meier analysis showed that median survival time (MST) for overall survival were 22.2 months for SF and 29.2 months for NAT (p=0.057). Focusing on the differences of strategy for NAT, we compared the clinical outcomes of patients between GS (n=36) and GnP (n=26). The mean of NAC duration was 3.2 months for GS and 2.8 months for GnP. Among the clinico-pathological parameters, no differences of backgrounds for patients were observed between these two regimens. The response rates for RECIST criteria were 33.3% for GS and 38.5% for GnP. The decrease rate of CA19-9 during NAC were 51.6% for GS and 67.7% for GnP (p=0.07), whereas the rate of N2 positive in GS was significantly lower than that in GnP (p=0.009). The MST for overall survival were 29.2 months for GS and 24.2 months for GnP in BR, notably, 40.0 months for GS and 27.1 months for GnP in BR-A. Randomized prospective studies for the optimal NAC will be warranted for the strategy of treatment for patients with BR PDAC.