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Textbook Neoadjuvant Experience: Defining a Novel Composite Outcomes Measure for Patients with Pancreatic Cancer

Patrick W Underwood1, Thomas Leuschner1, Aslam Ejaz2

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A textbook neoadjuvant experience (TNE) is rarely achieved in pancreatic cancer patients receiving neoadjuvant therapy (NT). Achieving a TNE significantly improves overall survival, highlighting its importance for treatment success.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Neoadjuvant therapy (NT) is increasingly utilized for pancreatic ductal adenocarcinoma (PDAC).
  • Challenges in NT include disease progression, toxicity, and failure to complete surgical resection.
  • Optimizing NT delivery and outcomes requires robust metrics.

Purpose of the Study:

  • To define and validate a novel composite outcome metric for successful NT delivery in PDAC.
  • To assess the frequency of achieving a 'textbook neoadjuvant experience' (TNE).
  • To evaluate the association between TNE and patient survival outcomes.

Main Methods:

  • Retrospective evaluation of 306 localized PDAC patients receiving NT (2018-2023).
  • Definition of TNE: absence of mortality, disease progression, or hospitalization during NT, plus completion of NT and successful resection.
  • Multivariable Cox regression analysis to identify predictors of overall survival.

Main Results:

  • Only 28% of patients achieved a TNE.
  • TNE was more common in potentially resectable (47%) than borderline resectable (29%) or locally advanced (7%) PDAC.
  • Patients with a TNE had significantly longer overall survival (not reached vs. 16.4 months, p < 0.001).
  • TNE was the strongest predictor of improved overall survival (HR 0.33, p < 0.001).

Conclusions:

  • A textbook neoadjuvant experience (TNE) is infrequently achieved in PDAC patients undergoing neoadjuvant therapy.
  • TNE is strongly associated with improved long-term survival.
  • This composite metric should be incorporated into future research to better reflect treatment success and guide optimization strategies for NT in PDAC.