Neoadjuvant Therapy For Pancreatic Cancer Research Articles

Tumor resectability and response on CT following neoadjuvant therapy for pancreatic cancer: inter-observer agreement study.

First, to measure inter-observer agreement regarding tumor resectability and response, and second, to measure diagnostic performance in predicting negative resection margin, on re-staging CTs of patients who received neoadjuvant therapy for pancreatic cancer. This retrospective study included patients who received neoadjuvant therapy for borderline resectable pancreatic cancer from 2017 to 2020. Six readers independently evaluated initial staging and re-staging CT images. They categorized the resectability on re-staging CT based on the NCCN guideline, and evaluated tumor response to neoadjuvant therapy according to our proposed criteria on a 5-grade scale. For inter-observer agreement, Gwet's agreement coefficients were used. A crossed random effect model was used to pool the sensitivity and specificity of six readers in predicting negative resection margin. Seventy-seven patients with the median age of 66 (59-70) were included. The pooled agreement for tumor resectability was 0.64 (95% CI, 0.56-0.71) for differentiating the three categories, and 0.84 (0.77-0.91) for differentiating resectable or borderline resectable cancer vs. unresectable cancer. Agreement for tumor response grade was 0.89 (0.85-0.92). The pooled sensitivity and specificity for predicting negative resection margin were 48% (43-52%) and 61% (57-64%), respectively, when only "resectable" on re-staging CT was considered as index test positive. When either "resectable"' or "borderline resectable" was considered as positive, the pooled sensitivity and specificity were 91% (89-94%) and 5% (4-6%), respectively. CT can be used reliably with a high inter-observer agreement in selecting candidates for surgery after neoadjuvant therapy of pancreatic cancer. • On CT following neoadjuvant therapy of pancreatic cancer, six readers showed high agreement in differentiating resectable or borderline resectable vs. unresectable cancer (Gwet's coefficient, 0.84). • Inter-observer agreement was also high for our proposed tumor response grade (Gwet's coefficient, 0.89). • Specificity was very low (5%) while sensitivity was high (91%) when either resectable or borderline resectable cancer on re-staging CT was considered as predictive of negative resection margin status.

辅助与新辅助治疗对于胰腺癌的研究前景

辅助与新辅助治疗对于胰腺癌的研究前景

Current status and challenges of accurate preoperative assessment of pancreatic cancer

Pancreatic cancer is a malignant tumor with very poor prognosis. In the past decade, the surgical technique has made significant progress, but it has not brought desired effect in improving the survival outcome of pancreatic cancer patients. With the development of the concept of cancer treatment and the emergence of precision medicine, the surgical centered multidisciplinary treatment and collaborative diagnosis and treatment mode has gradually become the mainstream. Accurate preoperative assessment of pancreatic cancer has become a breakthrough for further improving the prognosis of patients with pancreatic cancer. From the perspective of precise assessment, this paper mainly summarized the status and progress on the following four aspects: the preoperative diagnosis and staging, the resectability evaluation, the neoadjuvant therapy strategy and efficacy evaluation of neoadjuvant therapy in pancreatic cancer, and also discussed the shortcomings and challenges in the field of precise assessment, finally in order to make the preoperative assessment of pancreatic cancer more precise and standard, and to provide useful reference for future research work.

The Chinese guidelines for neoadjuvant therapy of pancreatic cancer (2020)

Abstract Aiming to keep pace with the renewal of international guidelines and refine the domestic treatment system of pancreatic cancer, the Chinese Pancreatic Surgery Association, Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association launched this Chinese guidelines for neoadjuvant therapy of pancreatic cancer (2020 edition). Based on the Grading of Recommendations Assessment, Development, and Evaluation system, the guidelines have conducted a discussion on the indication, regimen selection, therapeutic effect evaluation, pathological diagnosis, surgery strategy, etc. The guidelines have quantified the evidence level of the current clinical researches and provided recommendations for the clinical practice in neoadjuvant therapy of pancreatic cancer. The guidelines have highlighted the role of multiple disciplinary team and represented the conversion of treatment concepts in pancreatic cancer. Neoadjuvant therapy has prolonged the survival of part of pancreatic cancer patients. However, more high-quality clinical researches are in urgent need to improve the level of evidence, optimize the clinical practice, and improve the survival of patients.

Neoadjuvant Therapy for Pancreatic Cancer: What Is the Optimal Duration of Treatment?

Neoadjuvant Therapy for Pancreatic Cancer: What Is the Optimal Duration of Treatment?

Weight loss during neoadjuvant therapy for pancreatic cancer does not predict poor outcomes

BackgroundWeight changes during neoadjuvant chemotherapy (NAC) for pancreatic cancer (PDAC) are not well studied. We hypothesized that weight loss may predict poor outcomes. MethodsWeight change from NAC initiation to pancreatectomy was grouped: gain (≥5%), stable, and loss (≥5%). Pathologic, postoperative, and survival outcomes were compared. Results95 patients were included: 31.6% lost weight, 58.9% maintained weight, and 9.5% gained weight. There were no differences in chemotherapeutic regimens. Median recurrence-free survival (RFS) and overall survival (OS) were similar between patients with stable weight and those who lost weight (RFS: 9.6vs14.0months; OS: 25.8vs26.7months). Among those who gained weight, RFS (29.5months) and OS (38.4months) were greater relative to the other weight categories. On multivariable regression, weight gain was associated with improved RFS compared to loss (HR = 0.16). ConclusionMost patients maintain or lose weight during NAC, and weight loss does not predict poor outcomes. Weight gain may predict improved RFS.

Plastic or self-expandable metal stent: Which is the most suitable for patients with pancreatic head cancer in the upcoming era of neoadjuvant chemotherapy? A review.

Obstructive jaundice is a major symptom of pancreatic head cancer, and although its amelioration is required before scheduling chemotherapy, the decision to perform biliary drainage for resectable pancreatic cancer has remained controversial. In recent years, the effectiveness of neoadjuvant therapy for pancreatic cancer has been reported. Preoperative biliary drainage has become increasingly necessary, making the choice of stent an important one; thus, the longer the waiting period extends through neoadjuvant chemotherapy, the more durable stents - such as self-expandable metallic stents, rather than plastic stents - would be desired as an option. Still, there is insufficient evidence regarding surgical outcomes and long-term prognosis, and further confirmatory studies are needed. Through this review, we aim to provide an update on the characteristics of biliary stents and preoperative biliary drainage for potentially resectable pancreatic cancer.

Analysis of the Curative Effect of Neoadjuvant Therapy on Pancreatic Cancer.

The prevalence of pancreatic cancer is sharply increasing recently, which significantly increases the economic burden of the population. At present, the primary treatment of resectable pancreatic cancer is surgical resection, followed by chemotherapy with or without radiation. However, the recurrence rates remain high even after R0 resection. This treatment strategy does not distinguish undetected metastatic disease, and it is prone to postoperative complications. Neoadjuvant therapies, including neoadjuvant chemotherapy and radiotherapy, is being increasingly utilized in borderline resectable as well as resectable pancreatic cancer. This review summarized and discussed clinical trials of neoadjuvant therapy for pancreatic cancer, comparing resection rates, outcome measures, and adverse reactions between neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy.

Association of total neoadjuvant therapy with major pathologic response and survival in localized pancreatic cancer: A multi-institutional analysis of 504 patients.

4145 Background: Despite increased utilization of neoadjuvant therapy for pancreatic cancer (PC), a substantial proportion of patients never receive adjuvant therapy. We examined if total neoadjuvant therapy (TNT) would facilitate delivery of all prescribed (≥6 months) non-surgical therapy (NST: chemotherapy ± radiation) to improve oncologic outcomes. Methods: Patients receiving neoadjuvant FOLFIRINOX or gemcitabine/nab-paclitaxel ±radiation followed by pancreatectomy at 7 centers were reviewed. Patients receiving TNT (≥6 months NST pre-resection) were compared to those receiving < 6 months ( < TNT). Primary outcomes were major (complete/near-complete) pathologic response (MPR) and overall survival (OS). Results: Of 504 patients, 105 (21%) were selected for TNT. TNT and < TNT patients had similar performance status and rates of borderline resectable/locally advanced disease (82% vs. 80%). TNT patients were significantly more likely to receive ≥6 months NST (100% vs. 31%; p < 0.001) vs. < TNT. While selection of chemotherapy regimen (FOLFIRINOX or gemcitabine/nab-paclitaxel) did not differ between TNT and < TNT cohorts, TNT patients were more likely to receive neoadjuvant radiation (44% vs. 25%, p < 0.001). Rates of vascular resection, postoperative complications, and mortality were similar between groups. TNT was associated with decreased rates of lymphovascular/perineural invasion (p = 0.002) and nodal positivity (p = 0.001), and increased rates of MPR (41% vs. 23%; p = 0.001) and pathologic complete response (13% vs. 6%; p = 0.02). TNT was associated with improved OS compared with < TNT (median 38 vs. 30 months; p = 0.039). Both MPR (median 38 [MPR] vs. 28 [limited response] months; p = 0.002) and ≥6 months NST (TNT or peri-operative) (median 38 [≥6m] vs. 26 [ < 6m] months; p = 0.001) were associated with improved OS. Addition of radiation was not associated with MPR or OS. Conclusions: The TNT approach allows more patients with localized PC to receive ≥6 months NST and is associated with improved rates of MPR and OS. TNT should be considered for all patients with operable PC when possible.

Challenges and stratigies of neoadjuvant therapy for pancreatic cancer

In recent years, more and more attention has been paid on the role of neoadjuvant therapy in the comprehensive treatment of pancreatic cancer. There is increasing evidence indicates that neoadjuvant therapy improves the R0 resection rate and patient's prognosis. However, the indication, therapy selection and efficacy evaluation of neoadjuvant therapy in patients with pancreatic cancer are still controversial, thus its clinical application is not very mature. This article aims to analyze the clinical implementation dilemma of neoadjuvant therapy for pancreatic cancer, and discuss the scientific and reasonable neoadjuvant treatment mode for pancreatic cancer patients.

Current status and controversy of neoadjuvant therapy in pancreatic cancer

Pancreatic cancer is considered to be the most malignant digestive tract tumor due to its high invasiveness, metastasis and recurrence rate. In recent years, neoadjuvant therapy has brought new insights to the treatment of pancreatic cancer. To date, the value of neoadjuvant therapy in pancreatic cancer has been widely recognized, but there is a lack of specific regimens. The superiority and inferiority of various regimens are still uncertain, therefore, the efficacy of neoadjuvant therapy can be evaluated combined with imaging, functional and biological markers.

Indications and efficacy of neoadjuvant therapy for pancreatic cancer

Pancreatic cancer has a high degree of malignancy, with a poor prognosis. Although surgical resection remains the only way to cure pancreatic cancer at present, the treatment mode has changed from "surgery priority" to "multidisciplinary cooperation" with the development of adjuvant therapy. Neoadjuvant therapy has been documented to increase the R0 resection rate of borderline resectable and locally advanced pancreatic cancer and improve the prognosis of the patients, and there has been a consensus on neoadjuvant therapy for these patients. However, there is still much controversy in the choice of neoadjuvant chemotherapy, the status of radiotherapy, imaging and pathological evaluation after neoadjuvant therapy for pancreatic cancer.

Impact of neoadjuvant therapy on the perioperative complications of pancreatic cancer

Pancreatic cancer is one of the most malignant digestive tract tumors with a 5-year survival rate of less than 10%. Surgery remains the basis of long-term survival of pancreatic cancer patients. With the progress of chemotherapy, neoadjuvant therapy has been gradually carried out in pancreatic cancer. There are more and more studies on the effects of neoadjuvant therapy on perioperative complications of pancreatic cancer, but the results are not consistent. This article reviews the recent studies on neoadjuvant therapy for pancreatic cancer and analyzes the impact of some key factors on perioperative complications.

Effectiveness of Adjuvant Therapy in Patients with Pancreatic Cancer Who Underwent Neoadjuvant Therapy.

Neoadjuvant therapy (NAT) is used to treat not only advanced pancreatic cancer but also resectable lesions. The present study investigated the effectiveness of postoperative adjuvant chemotherapy for patients with pancreatic cancer who underwent surgical resection after NAT. Patients who underwent macroscopically curative resection after NAT for pancreatic cancer were enrolled. Adjuvant chemotherapy was defined as at least 1 cycle of planned chemotherapy within 3 months after the date of surgery and included S-1, gemcitabine, or both. We retrospectively examined the effect of adjuvant chemotherapy on overall survival (OS) and recurrence-free survival (RFS) as a function of patients' clinicopathological factors. Ninety-seven patients were included in the study, of which 68 (70.1%) underwent adjuvant chemotherapy. Administration of adjuvant chemotherapy was significantly associated with prolonged OS and RFS in patients whose elevated levels of carbohydrate antigen 19-9 or duke pancreatic monoclonal antigen type-2 did not normalize after NAT. In patients with pathological lymph node metastasis, the administration of adjuvant chemotherapy was significantly associated with longer OS but did not improve PFS. Postoperative adjuvant chemotherapy was associated with prolonged postoperative survival in patients with pancreatic cancer who did not sufficiently respond to NAT as judged by tumor marker expression.

Neoadjuvant therapy for pancreatic cancer: Limitations and advances of response assessment (Review).

Neoadjuvant therapy (NAT) has been widely recommended for managing patients with borderline resectable pancreatic cancer and resectable tumors with high risk factors. Accurate evaluation of the response after NAT is crucial to decide surgery, which then improves the rate of R0 resection and avoids meaningless surgery. The response to NAT is currently evaluated by conventional radiological examination and changes of serum CA19‑9 levels. However, these assessments cannot accurately reflect the response to NAT. This article describes the limitations and advances of NAT response evaluation in pancreatic cancer. The values of some traditional imaging techniques, including positron emission tomography, endoscopic ultrasound, and diffusion weighted magnetic resonance imaging, are discussed, as well as novel imaging modalities or biomarkers, such as radiomics, dual energy computed tomography and liquid biopsy.

Another Potential Benefit of Neoadjuvant Therapy in Pancreatic Cancer: Reduction in Postoperative Readmission Rates

Another Potential Benefit of Neoadjuvant Therapy in Pancreatic Cancer: Reduction in Postoperative Readmission Rates

Biliary complications during neoadjuvant therapy for pancreatic cancer

Introduction: Neoadjuvant therapy prior to resection of pancreatic head cancer increases time to surgery and thus the possibility of biliary complications. We determined the frequency and impact of biliary complications during neoadjuvant therapy prior to resection. Methods: We completed a retrospective study of patients treated with neoadjuvant therapy for pancreatic head adenocarcinoma from May 2014 through March 2019. Results: Of the 59 patients identified, the average age was 67 and 50.8% were male. Neoadjuvant therapy regimens included gemcitabine and abraxane + chemo-radiation (28 patients, 47.5%), FOLFIRINOX + chemo-radiation (15 patients, 25.4%) and remaining 16 patients received alternative therapeutic combinations based on tolerance. Six (10.1%) patients died prior to completion of neoadjuvant therapy. After completion of all neoadjuvant therapy, 34 (57.6%) patients went on to resection while 19 (32.2%) showed disease progression precluding surgical extirpation. Biliary complications during neoadjuvant therapy affected 16 patients (27%). Biliary interventions included percutaneous cholecystostomy drain (3 patients, 5.1%), ERCP with stent placement or exchange (6 patients, 10.1%), percutaneous transhepatic drain (4 patients, 6.8%) and hospital admission for cholangitis with medical treatment only (2 patients, 3.3%). Eight of the 16 patients with biliary complications went on to surgical resection (50%) compared to 26 of the 43 (60.4%) patients who did not have biliary complications. (χ2=0.18, p = 0.67). Conclusion: Biliary complications during neoadjuvant therapy for pancreatic head cancer are relatively common, but do not significantly affect proceeding to surgical resection.

Advances and challenges of neoadjuvant therapy in pancreatic cancer.

Pancreatic cancer has been becoming the second cause of cancer death in the western world, and its disease burden has increased. Neoadjuvant therapy is one of the current research hotspots in the field of pancreatic cancer, aiming to improve the surgical rate and prognosis of pancreatic cancer. Based on the latest evidence, this review discussed neoadjuvant therapy in pancreatic cancer from the following three aspects: patient selection, protocols selection of neoadjuvant therapy, and treatment response evaluation and resectability prediction. A big controversy existed on the indications of neoadjuvant treatment, but it was agreed that any patient who is likely to achieve R0 resection due to neoadjuvant therapy should be the targeted population. A variety of chemotherapy regimens were tried for neoadjuvant therapy in pancreatic cancer, and FOLFIRINOX and Nab-Paclitaxel plus Gemcitabine are two preferred regimens at present. It was challenging to evaluate treatment response and predict resectability after neoadjuvant therapy, although imaging by CT is widely used. Based on new findings of the remarkable performance of several chemotherapy regimens with or without radiotherapy, the neoadjuvant indications of pancreatic cancer have extended in recent years. However, it is still a challenge to assess the neoadjuvant treatment response and determine the timing of surgery.

Patient experience and quality of life during neoadjuvant therapy for pancreatic cancer: a systematic review and study protocol.

Neoadjuvant therapy (NT) is increasingly being offered to patients with pancreatic ductal adenocarcinoma (PDAC) prior to surgical resection. However, the experience and quality of life (QOL) of patients undergoing NT are poorly understood. A systematic review of the Cinahl, Embase, Medline, Pubmed, Scopus, and Web of Science databases was conducted to evaluate the available literature pertaining to the experience and QOL of patient's undergoing NT for PDAC. Among 6041 articles screened, only six met criteria for full-text review including three prospective clinical trials of NT with QOL secondary endpoints. Overall, global QOL during or following NT did not significantly change from baseline. Pain scores seemed to improve during NT while the impact of NT on physical functioning varied across studies. No studies were identified evaluating other aspects of the patient experience. Although NT appears to have a minor impact on the QOL of patients with PDAC, this systematic review identified significant evidence gaps in the literature. A protocol of a prospective observational cohort study utilizing a digital smartphone app that aims to evaluate the patient experience and longitudinal QOL of patients with PDAC undergoing NT is presented.

The guideline for neoadjuvant therapy of pancreatic cancer in China (2020 edition)

In order to improve the overall treatment level of pancreatic cancer in China, Study Group of Pancreatic Surgery in China Society of Surgery of Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association have formulated the guideline for neoadjuvant therapy of pancreatic cancer in China (2020 edition). Based on the GRADE system, the guideline has conducted a discussion on the indication, regimen selection, therapeutic effect evaluation, pathological diagnosis and surgery strategy, etc. This guideline has quantified the evidence level of the current clinical researches and provided recommendations for the clinical practice in the neoadjuvant therapy of pancreatic cancer. The guideline has highlighted the role of multiple disciplinary team and represented the conversion of treatment concept in pancreatic cancer. Neoadjuvant therapy has prolonged the survival of the part of pancreatic cancer patients. However, more high-quality clinical researches are in urgent need to improve the level of evidence, optimize the clinical practice and improve the survival of patients.