The Survival Benefit of Chemoradiotherapy following Induction Chemotherapy with Gemcitabine Plus Nab-Paclitaxel for Unresectable Locally Advanced Pancreatic Cancer

Ryoji Takada,Hirofumi Akita,Hiroyuki Uehara,Kenji Ikezawa,Yutaro Abe,Nobuyasu Fukutake,Kazuyoshi Ohkawa,Reiko Ashida,Tasuku Nakabori,Makiko Urabe,Teruki Teshima,Yugo Kai,Takuo Yamai,Kazuma Daiku,Hidenori Takahashi,Shingo Maeda

doi:10.3390/cancers13184733

Ryoji Takada, Hirofumi Akita + Show 14 more

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https://doi.org/10.3390/cancers13184733

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Journal: Cancers	Publication Date: Sep 21, 2021
Citations: 13	License type: CC BY 4.0

Affiliation: Osaka International Cancer Institute

Abstract

Simple SummaryAn optimal therapeutic strategy for unresectable locally advanced pancreatic cancer (UR-LAPC) has not been established. The aim of this retrospective study was to evaluate the therapeutic efficacy, progression-free survival (PFS), and overall survival (OS) of patients with UR-LAPC who underwent gemcitabine plus nab-paclitaxel (GnP) as first-line chemotherapy followed by chemoradiotherapy (CRT) compared to chemotherapy alone (CTx) at our department in a Japanese cancer referral center between February 2015 and July 2018. CRT resulted in significantly better PFS and OS than CTx. In the multivariate analyses, CRT following induction chemotherapy was identified as an independent prognostic factor for OS. In summary, patients with UR-LAPC experienced favorable treatment outcomes after receiving GnP as the first-line chemotherapy, especially when receiving additional CRT after tailored courses of induction chemotherapy. Thus, this treatment strategy represents a promising treatment option for selected patients with UR-LAPC.An optimal therapeutic strategy for unresectable locally advanced pancreatic cancer (UR-LAPC) has not been established. This study investigated the therapeutic efficacy of chemoradiotherapy (CRT) following induction chemotherapy with gemcitabine plus nab-paclitaxel (GnP) (CRT group) compared with systemic chemotherapy alone (CTx group) in patients with UR-LAPC. This was a retrospective study of 63 consecutive patients with UR-LAPC treated at our department in a Japanese cancer referral center between February 2015 and July 2018. We excluded patients who underwent other regimens and those enrolled in another prospective study. The CRT group (n = 25) exhibited significantly better progression-free survival (PFS) and overall survival (OS) than the CTx group (n = 20, PFS 17.9 vs. 7.6 months, p = 0.044; OS 29.2 vs. 17.4 months, p < 0.001). In the multivariate analyses, CRT following induction chemotherapy was identified as an independent prognostic factor for OS. Seven (15.6%) patients underwent conversion surgery, all of whom were in the CRT group. The R0 resection rate was 85.7% (6/7). In summary, patients with UR-LAPC experienced favorable treatment outcomes after receiving GnP as the first-line chemotherapy, especially when receiving additional CRT. Thus, this treatment strategy represents a promising treatment option for selected patients with UR-LAPC.

Highlights

Pancreatic cancer (PC) has one of the worst prognoses among diseases worldwide [1,2] despite recent progress in chemotherapy, which has improved the survival of patients with PC [3,4,5,6]
unresectable locally advanced PC (UR-LAPC) was defined as no apparent distant metastasis except for regional lymph node metastasis, tumor contact with the celiac artery (CA) or superior mesenteric artery (SMA) > 180◦, tumor contact with the aorta, surgically unresectable tumor with common hepatic artery and/or gastroduodenal artery involvement, or surgically unresectable tumor with portal vein (PV)/superior mesenteric vein (SMV) involvement according to National Comprehensive Cancer Network (NCCN) guidelines [7]
Primary tumors were located at the pancreatic head in 31 (68.9%) patients and at the pancreatic body/tail in 14 (31.1%) patients

Summary

Introduction

Pancreatic cancer (PC) has one of the worst prognoses among diseases worldwide [1,2] despite recent progress in chemotherapy, which has improved the survival of patients with PC [3,4,5,6]. UR-LAPC accounts for 10–20% of PC cases [8,9], and is considered unresectable even in the absence of metastatic disease due to its high involvement with nearby structures. According to National Comprehensive Cancer Network (NCCN) guidelines, systemic chemotherapy is generally recommended for patients with UR-LAPC to prolong overall survival (OS) and improve quality of life [7]. CRT could prevent or delay local progression and improve medium- to long-term survival rates in patients with UR-LAPC [10,11]. Despite two randomized controlled trials (RCTs), the effect of upfront CRT on OS in patients with UR-LAPC remains controversial [11,12]

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