Total Neoadjuvant Therapy for Operable Pancreatic Cancer
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ORIGINAL ARTICLE – PANCREATIC TUMORS
Total Neoadjuvant Therapy for Operable Pancreatic Cancer Rebecca Y. Kim, MD, MPH1, Kathleen K. Christians, MD1, Mohammed Aldakkak, MD1, Callisia N. Clarke, MD1, Ben George, MD2, Mandana Kamgar, MD, MPH2, Abdul H. Khan, MD3, Naveen Kulkarni, MD4, William A. Hall, MD5, Beth A. Erickson, MD5, Douglas B. Evans, MD1, and Susan Tsai, MD, MHS1 1
Department of Surgery, Mary Anne and Charles LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI; 2Department of Medicine, Division of Hematology and Oncology, Mary Anne and Charles LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI; 3Department of Medicine, Division of Gastroenterology and Hepatology, Mary Anne and Charles LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI; 4Department of Radiology, Mary Anne and Charles LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI; 5Department of Radiation Oncology, Mary Anne and Charles LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI
ABSTRACT Background. Overall survival (OS) for operable pancreatic cancer (PC) is optimized when 4–6 months of nonsurgical therapy is combined with pancreatectomy. Because surgery renders the delivery of postoperative therapy uncertain, total neoadjuvant therapy (TNT) is gaining popularity. Methods. We performed a retrospective cohort study of patients with operable PC and compared TNT with shorter course neoadjuvant therapy (SNT). Primary outcomes of interest included completion of neoadjuvant therapy (NT) and resection of the primary tumor, receipt of 5 months of nonsurgical therapy, and median OS. Results. We reviewed 541 consecutive patients from 2009 to 2019 including 226 (42%) with resectable PC and 315 (58%) with borderline resectable (BLR) PC. The median age was 66 years (IQR [59, 72]), and 260 (48%) patients were female. TNT was administered to 89 (16%) patients and SNT was administered to 452 (84%). Both groups were equally likely to complete intended NT and surgery (p = 0.90). Patients who received TNT and surgical resection were more likely to have a complete pathologic
Ó Society of Surgical Oncology 2020 First Received: 9 April 2020 Accepted: 16 August 2020 S. Tsai, MD, MHS e-mail: [email protected]
response (8% vs 4%, p \ 0.01) and were more likely to receive at least 5 months of nonsurgical therapy (67% vs 45%, p \ 0.01). The median OS was 26 months [IQR (15, 57)]; not reached among patients treated with TNT, and 25 months [IQR (15, 56)] among patients treated with SNT (p = 0.19). Conclusions. TNT ensures the delivery of intended systemic therapy prior to a complicated operation without decreasing the chance of successful surgery; a window of operability was not lost. Patients who can tolerate SNT will likely benefit from TNT.
Overall survival (OS) for operable pancreatic cancer (PC) is optimized when multimodal therapy, including 6 months of chemotherapy with or without radiation therapy, is combined with surgical resect
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