Neoadjuvant therapy (NAT) and its role for pancreatic adenocarcinoma (PC) in the current era: Institutional experience.

Abstract

672 Background: PC affects 57,000 people in the U.S. annually with poor long-term outcomes. NAT for localized disease has increasingly been used but lacks robust prospective data. We investigated the disease course and outcomes for patients (pts) undergoing NAT versus upfront surgery for PC at a high-volume academic center. Methods: Utilizing our IRB-approved retrospective database of metastatic PC pts (year 2000-2017), we identified pts who presented with localized disease and were considered for surgery and present the baseline tumor and treatment characteristics here. Fisher’s exact and Wilcoxon Rank-Sum tests were used for categorical data and Kaplan Meier (KM) curves for survival data when comparing those who had upfront surgery versus surgery following NAT. Results: 352 pts with localized disease at diagnosis were included in our analysis with median age of 65 y (range 38-89) and 45% females. NAT was used in 225 (64%) pts while 109 pts (31%) had upfront surgery and 18 pts (5%) received no treatment. Adjuvant therapy was given to 77% of pts after upfront surgery and 48% of pts after surgery following NAT. NAT regimen consisted of chemotherapy (CTx) and radiation for 48%, CTx alone for 8% and radiotherapy alone for 44% of pts. Of those receiving CTx, 24% received triple agent while 51% and 25% received dual and single agent therapy. Pt factors (age, CCI, gender, BMI, smoking status, race) did not differ between those receiving upfront surgery and surgery following NAT but upfront surgery was associated with a lower stage at diagnosis (p < 0.0001). Surgical resection after NAT occurred in 79 pts (35%) with median overall survival of 26.3m vs 19.7m (p = 0.06) in those who had upfront surgery. Survival rates at year 1, 3, and 5 years were 94%, 34%, and 8% for those with NAT followed by surgery vs 76%, 17%, and 11% for those with upfront surgery (p = 0.06). Conclusions: Use of NAT is prevalent, yet only 35% of pts make it to surgical resection. Survival was improved for pts who underwent resection following NAT versus upfront, although the difference was not statistically significant. Additional research is warranted to define the optimal NAT approach for pts with borderline resectable PC.