Use and outcomes from neoadjuvant chemotherapy in borderline resectable pancreatic ductal adenocarcinoma in an Australasian population

被引：1

作者：

Walpole, Imogen ^{[1
]}

Lee, Belinda ^{[1
,2
,3
]}

Shapiro, Jeremy ^{[4
,5
]}

Thomson, Benjamin ^{[6
,7
]}

Lipton, Lara ^{[4
,7
]}

Ananda, Sumitra ^{[7
,8
]}

Usatoff, Val ^{[4
,8
]}

Mclachlan, Sue-Ann ^{[9
]}

Knowles, Brett ^{[7
,9
]}

Fox, Adrian ^{[9
,10
]}

Wong, Rachel ^{[2
,10
,11
]}

Cooray, Prasad ^{[12
]}

Burge, Matthew ^{[13
]}

Clarke, Kate ^{[14
]}

Pattison, Sharon ^{[15
]}

Nikfarjam, Mehrdad ^{[16
,17
]}

Tebbutt, Niall ^{[16
]}

Harris, Marion ^{[18
]}

Nagrial, Adnan ^{[19
]}

Zielinski, Rob ^{[20
,21
,22
]}

Chee, Cheng Ean ^{[2
,23
]}

Gibbs, Peter ^{[2
,3
]}

机构：

[1] Northern Hosp, Dept Med Oncol, Victoria, Australia

[2] Walter & Eliza Hall Inst Med Res, Melbourne, Vic, Australia

[3] Univ Melbourne, Fac Med, Fac Med & Hlth Sci, Melbourne, Vic, Australia

[4] Cabrini Hlth, Dept Med Oncol, Malvern, Vic, Australia

[5] Monash Univ, Fac Med & Hlth Sci, Melbourne, Vic, Australia

[6] Univ Melbourne, Royal Melbourne Hosp, Dept Surg, Melbourne, Vic, Australia

[7] Peter MacCallum Canc Ctr, Dept Med Oncol, Melbourne, Vic, Australia

[8] Western Hlth, Dept Med Oncol, Melbourne, Vic, Australia

[9] St Vincents Hosp, Dept Med Oncol, Melbourne, Vic, Australia

[10] Eastern Hlth, Dept Med Oncol, Melbourne, Vic, Australia

[11] Epworth Med Fdn, Dept Med Oncol, Melbourne, Vic, Australia

[12] Knox Private Hosp, Dept Med Oncol, Wantirna, Vic, Australia

[13] Royal Brisbane Hosp, Dept Med Oncol, Herston, Qld, Australia

[14] Wellington Hosp, Dept Med Oncol, Wellington, New Zealand

[15] Univ Otago, Dunedin Sch Med, Dept Med, Dunedin, New Zealand

[16] Austin Hlth, Dept Med Oncol, Melbourne, Vic, Australia

[17] Warringal Private Hosp, Dept Surg, Heidelberg, Vic, Australia

[18] Monash Med Ctr, Dept Med Oncol, Clayton, Vic, Australia

[19] Westmead Hosp, Dept Med Oncol, Westmead, NSW, Australia

[20] Orange Hosp, Dept Med Oncol, Orange, NSW, Australia

[21] Dubbo Base Hosp, Dept Med Oncol, Dubbo, NSW, Australia

[22] Bathurst Base Hosp, Dept Med Oncol, W Bathurst, NSW, Australia

[23] Natl Univ Canc Inst, Dept Med Oncol, Singapore, Singapore

来源：

ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY | 2023年 / 19卷 / 01期

关键词：

drug therapy; general surgery; mortality; neoadjuvant therapy; pancreatic neoplasms; PHASE-III; GEMCITABINE MONOTHERAPY; INDUCTION CHEMOTHERAPY; CANCER; FOLFIRINOX; CHEMORADIOTHERAPY; RADIOTHERAPY; SURVIVAL; TRIAL; OXALIPLATIN;

D O I：

10.1111/ajco.13807

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background Use of neoadjuvant (NA) chemotherapy is recommended when pancreatic ductal adenocarcinoma (PDAC) is borderline resectable Method A retrospective analysis of consecutive patients with localized PDAC between January 2016 and March 2019 within the Australasian Pancreatic Cancer Registry (PURPLE, Pancreatic cancer: Understanding Routine Practice and Lifting End results) was performed. Clinicopathological characteristics, treatment, and outcome were analyzed. Overall survival (OS) comparison was performed using log-rank model and Kaplan-Meier analysis. Results The PURPLE database included 754 cases with localised PDAC, including 148 (20%) cases with borderline resectable pancreatic cancer (BRPC). Of the 148 BRPC patients, 44 (30%) underwent immediate surgery, 80 (54%) received NA chemotherapy, and 24 (16%) were inoperable. The median age of NA therapy patients was 63 years and FOLFIRINOX (53%) was more often used as NA therapy than gemcitabine/nab-paclitaxel (31%). Patients who received FOLFIRINOX were younger than those who received gemcitabine/nab-paclitaxel (60 years vs. 67 years, p = .01). Surgery was performed in 54% (43 of 80) of BRPC patients receiving NA chemotherapy, with 53% (16 of 30) achieving R0 resections. BRPC patients undergoing surgery had a median OS of 30 months, and 38% (9 of 24) achieved R0 resection. NA chemotherapy patients had a median OS of 20 months, improving to 24 months versus 10 months for patients receiving FOLFIRINOX compared to gemcitabine/nab-paclitaxel (Hazard Ratio (HR) .3, p < .0001). Conclusions NA chemotherapy use in BRPC is increasing in Australia. One half of patients receiving NA chemotherapy proceed to curative resection, with 53% achieving R0 resections. Patients receiving Infusional 5-flurouracil, Irinotecan and Oxaliplatin (FOLIRINOX) had increased survival than gemcitabine/nab-paclitaxel. Treatment strategies are being explored in the MASTERPLAN and DYNAMIC-Pancreas trials.

引用

页码：214 / 225

页数：12

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