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Total neoadjuvant therapy for pancreatic adenocarcinoma increases probability for a complete pathologic response
Dany Barrak1, Anthony M Villano1, Nicole Villafane-Ferriol1
1Departments of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
Summary
Total neoadjuvant therapy (TNT) significantly increases the likelihood of achieving a pathologic complete response (pCR) in pancreatic cancer patients. Achieving a pCR with TNT is associated with improved overall survival (OS) compared to other neoadjuvant treatments.
Area of Science:
- Surgical Oncology
- Medical Oncology
- Gastroenterology
Background:
- Pancreatic adenocarcinoma treatment often involves neoadjuvant therapy, with protocols including chemotherapy (CT), chemoradiation (CRT), and total neoadjuvant therapy (TNT).
- Pathologic complete response (pCR) is an uncommon outcome in pancreatic cancer treated with neoadjuvant therapy.
- The study investigates the hypothesis that TNT may lead to higher pCR rates and improved overall survival (OS).
Purpose of the Study:
- To compare the efficacy of total neoadjuvant therapy (TNT) versus other neoadjuvant regimens (CT, CRT) in achieving pathologic complete response (pCR).
- To evaluate the association between achieving pCR and overall survival (OS) in pancreatic cancer patients.
- To determine if TNT confers a higher likelihood of pCR compared to traditional neoadjuvant therapies.
Main Methods:
- Retrospective review of the National Cancer Database (NCDB) from 2006 to 2016.
- Inclusion criteria: patients with locally advanced or borderline resectable pancreatic adenocarcinoma treated with neoadjuvant therapy followed by pancreatic resection.
- pCR defined as down-staging to pathologic stage 0; multivariate analysis used to compare treatment outcomes.
Main Results:
- A total of 5402 patients were analyzed; 177 (3.3%) achieved pCR.
- Multivariate analysis showed TNT was significantly more likely to achieve pCR than CRT (OR 1.67) or CT (OR 2.61).
- Patients achieving pCR had significantly higher OS (median 64.9 months) compared to those without pCR (median 21.6 months).
Conclusions:
- Total neoadjuvant therapy (TNT) may increase the likelihood of achieving a pathologic complete response (pCR) in pancreatic cancer.
- Achieving pCR is strongly associated with a significant improvement in overall survival (OS).
- TNT should be considered for patients undergoing neoadjuvant therapy for pancreatic cancer to potentially enhance pCR rates and survival outcomes.
