Total Neoadjuvant Therapy for Operable Pancreatic Cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Optimizing overall survival (OS) in operable pancreatic cancer (PC) involves combining neoadjuvant therapy with pancreatectomy.
• Uncertainty in delivering postoperative therapy after surgery has increased the popularity of total neoadjuvant therapy (TNT).

Purpose of the Study:

• To compare the outcomes of total neoadjuvant therapy (TNT) versus shorter neoadjuvant therapy (SNT) in patients with operable pancreatic cancer.
• To evaluate the impact of TNT on neoadjuvant therapy completion, surgical resection, duration of nonsurgical therapy, and overall survival.

Main Methods:

• Retrospective cohort study of 541 patients with operable pancreatic cancer (resectable and borderline resectable).
• Comparison between patients who received TNT and those who received SNT.
• Primary outcomes included completion of neoadjuvant therapy, tumor resection, receipt of at least 5 months of nonsurgical therapy, and median OS.

Main Results:

• Both TNT and SNT groups had similar rates of neoadjuvant therapy completion and surgical resection (p=0.90).
• Patients receiving TNT were more likely to achieve a complete pathologic response (8% vs 4%, p<0.01) and receive at least 5 months of nonsurgical therapy (67% vs 45%, p<0.01).
• Median OS was not significantly different between TNT and SNT groups (not reached vs 25 months, p=0.19).

Conclusions:

• Total neoadjuvant therapy (TNT) facilitates the delivery of intended systemic therapy before surgery without negatively impacting operability.
• TNT ensures adequate nonsurgical treatment duration and increases the likelihood of a complete pathologic response.
• Patients who tolerate SNT may also benefit from TNT, suggesting its broader applicability.