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The role of neoadjuvant treatment in localized pancreatic cancer


Authors: R. Němeček 1 ;  M. Eid 2
Authors place of work: Klinika komplexní onkologické, péče LF MU a MOÚ, Brno 1;  Interní hematologická, a onkologická klinika, LF MU a FN Brno 2
Published in the journal: Rozhl. Chir., 2024, roč. 103, č. 11, s. 429-436.
Category: Review
doi: https://doi.org/10.48095/ccrvch2024429

Summary

Pancreatic carcinoma is a prognostically unfavorable cancer disease with growing incidence and mortality, which is the 3rd most common cause of cancer-related death in developed countries. The 5-year survival rate does not exceed 11% and is the lowest across all cancer diagnoses. Only about 20–30% of patients have resectable (RPC) or borderline resectable (BRPC) disease at the time of diagnosis. Radical resection is an essential therapeutic modality in these cases and is considered the only potentially curative procedure. Neoadjuvant chemotherapy and/or chemoradiotherapy is established mainly in BRPC. The role of neoadjuvant therapy in RPC is currently under investigation. This review article describes the current options, advantages and disadvantages of neoadjuvant treatment in BRPC and RPC.

Keywords:

pancreatic neoplasms – FOLFIRINOX – neoadjuvant – gemcitabine – nab-paclitaxel


Zdroje
1.           Siegel RL, Miller KD, Fuchs HE et al. Cancer statistics, 2022. CA Cancer J Clin 2022; 72(1): 7–33. doi: 10.3322/caac.21708.
2.           Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol 2019; 10(1): 10–27. doi: 10.14740/wjon1166.
3.           Conroy T, Pfeiffer P, Vilgrain V et al. Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2023; 34(11): 987–1002. doi: 10.1016/j.annonc.2023.08.009.
4.           Ghaneh P, Kleef J, Halloran CM et al. The impact of positive resection margins on survival and recurrence following resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma. Ann Surg 2019; 269(3): 520–529. doi: 10.1097/SLA.0000000000002557.
5.           Isaji S, Mizuno S, Windsor JA et al. International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology 2018; 18(1): 2–11. doi: 10.1016/j.pan.2017.11.011.
6.           Oettle H, Neuhaus P, Hochhaus A et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA 2013; 310(14): 1473–1481. doi: 10.1001/jama.2013.279201.
7.           Neoptolemos JP, Stocken DD, Bassi C et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection. JAMA 2010; 304(10): 1073–1081. doi: 10.1001/jama.2010.1275.
8.           Neoptolemos JP, Palmer DH, Ghaneh P et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 2017; 389(10073): 1011–1024. doi: 10.1016/S0140-6736(16)32409-6.
9.           Conroy T, Hammel P, Hebbar M et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med 2018; 379(25): 2395–2406. doi: 10.1056/NEJMoa1809775.
10.         Tempero MA, Pelzer U, O‘Reilly EM et al. Adjuvant nab-paclitaxel + gemcitabine in resected pancreatic ductal adenocarcinoma: results from a randomized, open-label, phase III trial. J Clin Oncol 2023; 41(11): 2007–2019. doi: 10.1200/JCO.22.01134.
11.         Cloyd MJ, Heh V, Pawlik TM et al. Neoadjuvant therapy for resectable and borderline resectable pancreatic cancer: a meta-analysis of randomized controlled trials. J Clin Med 2020; 9(4): 1129. doi: 10.3390/jcm9041129.
12.         Versteijne E, Vogel JA, Besselink MG et al. Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. Br J Surg 2018; 105(8): 946–958. doi: 10.1002/bjs.10870.
13.         Jang JY, Han Y, Lee H et al. Oncological benefits of neoadjuvant chemoradiation with gemcitabine versus upfront surgery in patients with borderline resectable pancreatic cancer: a prospective, randomized, open-label, multicenter phase 2/3 trial. Ann Surg 2018; 268(2): 215–222. doi: 10.1097/SLA.0000000000002705.
14.         Motoi F, kosuge T, Ueno H et al. Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP-05). Jpn J Clin Oncol 2019; 49(2): 190–194. doi: 10.1093/jjco/hyy190.
15.         Versteijne E, van Dam JL, Suker M et al. Neoadjuvant chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer: long-term results of the dutch randomized PREOPANC trial. J Clin Oncol 2022; 40(11): 1220–1230. doi: 10.1200/JCO.21.02233.
16.         Koerkamp BG, Janssen QP, van Dam JL et al. Neoadjuvant chemotherapy with FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy for borderline resectable and resectable pancreatic cancer (PREOPANC-2): a multicenter randomized controlled trial. Ann Oncol 2023; 34(Suppl 2): S1254–S1335. doi: 10.1016/S0923-7534(23)04149-2.
17.         Van Dam JL, Verkolf EMM, Dekker EN et al. Perioperative or adjuvant mFOLFIRINOX for resectable pancreatic cancer (PREOPANC-3): study protocol for a multicenter randomized controlled trial. BMC Cancer 2023; 23(1): 728. doi: 10.1186/s12885-023-11141-5.
18.         Labori KJ, Bratlie SO, Andersson B et al. Neoadjuvant FOLFIRINOX versus upfront surgery for resectable pancreatic head cancer (NORPACT-1): a multicentre, randomised, phase 2 trial. Lancet Gastroenterol Hepatol 2024; 9(3): 205–217. doi: 10.1016/S2468-1253(23)00405-3.
19.         Ghaneh P, Palmer D, Cicconi S et al. Immediate surgery compared with short-course neoadjuvant gemcitabine plus capecitabine, FOLFIRINOX, or chemoradiotherapy in patients with borderline resectable pancreatic cancer (ESPAC5): a four-arm, multicentre, randomised, phase 2 trial. Lancet Gastroenterol Hepatol 2023; 8(2): 157–168. doi: 10.1016/S2468-1253(22)00348-X.
20.         Sohal DPS, Duong MT, Ahmad SA et al. Efficacy of perioperative chemotherapy for resectable pancreatic adenocarcinoma: a phase 2 randomized clinical trial. JAMA Oncol 2021; 7(3): 421–427. doi: 10.1001/jamaoncol.2020.7328.
21.         Katz MHG, Shi Q, Meyers JP et al. Efficacy of preoperative mFOLFIRINOX vs mFOLFIRINOX plus hypofractionated radiotherapy for borderline resectable adenocarcinoma of the pancreas: the A021501 phase 2 randomized clinical trial. JAMA Oncol 2022; 8(9): 1263–1270. doi: 10.1001/jamaoncol.2022.2319.
22.         Janssen QP, Buettner S, Suker M et al. Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer: a systematic review and patient-level meta-analysis. J Natl Cancer Inst 2019; 111(8): 782–794. doi: 10.1093/jnci/djz073.
23.         Suker M, Beumer BR, Sadot E et al. FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis. Lancet Oncol 2016; 17(6): 801–810. doi: 10.1016/S1470-2045(16)00172-8.
24.         Golan T, Hammel P, Reni M et al. Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer. N Engl J Med 2019; 381(4): 317–327. doi: 10.1056/NEJMoa1903387.
25.         Pishvaian MJ, Blais EM, Brody JR et al. Outcomes in patients with pancreatic adenocarcinoma with genetic mutations in DNA damage response pathways: results from the know your tumor program. JCO Precis Oncol 2019; 3: 1–10. doi: 10.1200/PO.19.00115.
26.         Greenhalf W, Ghaneh P, Neoptolemos JP et al. Pancreatic cancer hENT1 expression and survival from gemcitabine in patients from the ESPAC-3 trial. J Natl Cancer Inst 2014; 106(1): djt347. doi: 10.1093/jnci/djt347.
27.         Nicolle R, Gayet O, Duconseil P et al. A transcriptomic signature to predict adjuvant gemcitabine sensitivity in pancreatic adenocarcinoma. Ann Oncol 2021; 32(2): 250–260. doi: 10.1016/j.annonc.2020.10.601.
28.         Meulendijks D, Henricks LM, Sonke GS et al. Clinical relevance of DPYD variants c.1679T>G, c.1236G>A/HapB3, and c.1601G>A as predictors of severe fluoropyrimidine-associated toxicity: a systematic review and meta-analysis of individual patient data. Lancet Oncol 2015; 16(16): 1639–1650. doi: 10.1016/S1470-2045(15)00286-7.
29.         Karas S, Innocenti F. All you need to know about UGT1A1 genetic testing for patients treated with irinotecan: a practitioner-friendly guide. JCO Oncol Pract 2022; 18(4): 270–277. doi: 10.1200/OP.21.00624.
MUDr. Radim Němeček, Ph.D.
Klinika komplexní onkologické péče
LF MU a MOÚ
Žlutý kopec 7
656 53 Brno
ORCID autorů    
R. Němeček 0000-0001-6825-0960
M. Eid 0000-0002-4433-5326
Štítky
Surgery Orthopaedics Trauma surgery

Článok vyšiel v časopise

Perspectives in Surgery

Číslo 11

2024 Číslo 11
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