Neoadjuvant therapy for borderline resectable pancreatic ductal adenocarcinoma (PDA) involving a high volume pancreatic centre in Ireland

Abstract

Background: Neoadjuvant (NA) therapy for borderline resectable PDA patients (pts) appear to improve outcome [1, 2]. There is limited data with the use of FOLFIRINOX (FX) and Gemcitabine/nab-paclitaxel (GP). Methods: St. Vincent’s University Hospital (SVUH) is a national referral centre for PDA in Ireland. Pts were identified from the pancreatic MDT discussions. Borderline resectability as defined by the NCCN criteria. Primary endpoints were resection rate and median survival (mOS). Results: 93 pts were identified between 1 Jan 2012 and 31 Dec 2015 with median follow-up of 11.40 mos (95% CI 11.51 – 15.10). 50 (53%) were female with a median age of 67 years (range: 43 -78). NA chemotherapy was administered in 76 pts. Majority were treated with FX (24, 32%) and GP (20, 26%). 53/76, 82% pts had sequential radiation; 58% were treated with long course- and 42% with short course-radiation. 34/53, 64% were planned for surgery. Resection rate was 40% (21/53); 53% (16/30) with FX/GP v 22% (5/23) with other regimens, p=0.02. R0 resection rate was 76% (16/21); 88% with FX/GP v 40% other reg, p=0.03. mOS improved with FX/GP 19.87 mos v other reg 13.36 mos, p<0.005; including in those who were resected, 40.86 mos with FX/GP v 22.31 mos with other reg, p=0.02. There is a trend in improved resection rate between those treated with NA FX/GP in SVUH v other centres; 50% v 23% respectively, p=0.06. Conclusion: NA FFX/GNP improve resection, R0 resection and mOS. Treatment in high-volume specialist centre may improve resection outcome.