Multicenter Prospective Cohort Study of Neoadjuvant Chemotherapy for Borderline Resectable Pancreatic Cancer...

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Pancreatic cancer, particularly borderline resectable pancreatic cancer (BRPC) and resectable pancreatic cancer (RPC) involving major vessels, presents significant treatment challenges.
• Neoadjuvant chemotherapy (NAC) is increasingly explored as a strategy to improve surgical outcomes in these complex cases.
• Comparing NAC to upfront surgery is crucial for optimizing treatment pathways.

Purpose of the Study:

• To evaluate the effectiveness and safety of neoadjuvant chemotherapy (NAC) in patients with borderline resectable pancreatic cancer (BRPC) and resectable pancreatic cancer (RPC) involving major vessels.
• To compare outcomes of NAC followed by surgery against a historical control group treated with upfront surgery.
• To assess the R0 resection rate as the primary endpoint.

Main Methods:

• A multicenter prospective observational study enrolled patients with BRPC and RPC involving major vessels.
• Patients received NAC with physician-determined regimens and durations.
• Outcomes including R0 resection rate, safety, overall survival, and response rate were analyzed and compared to historical upfront surgery data.

Main Results:

• Of 52 enrolled patients, 50 were analyzed; 31 underwent resection, achieving an R0 resection in 26 patients (52% overall, 84% of resected).
• Age (≥75 years) was the sole independent predictor of nonresection.
• The prospective NAC cohort demonstrated longer median progression-free survival and overall survival compared to the historical upfront surgery cohort.

Conclusions:

• Neoadjuvant chemotherapy (NAC) in a real-world setting may achieve R0 resection rates comparable to those in prior clinical studies for BRPC.
• Developing safe NAC regimens and management strategies is essential to maintain treatment intensity, especially in geriatric patients.
• Further investigation into optimizing NAC protocols for elderly patients with pancreatic cancer is warranted.