The Fate of Resectable Pancreatic Adenocarcinoma Following Neoadjuvant Chemotherapy

Abstract

Background: Pancreatic cancer continues to be a major cause of cancer-related mortality. There has been a greater implementation of upfront chemotherapy for pancreatic adenocarcinoma patients. Although there are many theoretical benefits to neoadjuvant chemotherapy, its clinical impact is uncertain. We sought to understand the outcomes of patients with resectable and borderline-resectable pancreatic adenocarcinoma who undergo neoadjuvant chemotherapy. Methods: Patients were collected in a secure database from September 2018 to May 2020. Patients were excluded if they presented with locally advanced or metastatic disease, inability to complete chemotherapy or if they were not a surgical candidate. Anatomic resectability was determined by the 2017 International Consensus Definition. Results: 66 patients with resectable disease underwent chemotherapy. FOLFIRINOX was used in 41 (62%) patients, gemcitabine-based regimens in 28 (42%) patients (total greater than 100% as some patients underwent both regimens). Following re-staging, 47 patients (71.2%) were thought to have resectable disease. Of these patients, 36 have been successfully resected to date. Metastatic disease was found in 12 patients (18.2%) and 6 patients (9.1%) had locally advanced disease. Conclusion: Most patients with resectable pancreatic cancer are resected after neoadjuvant chemotherapy, but a subset will develop local or distant progression. Further studies will be needed to determine which patients will progress locally and may benefit from an upfront surgical approach.