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https://wslhd.intersearch.com.au/wslhdjspui/handle/1/7119
Title: | Use and outcomes from neoadjuvant chemotherapy in borderline resectable pancreatic ductal adenocarcinoma in an Australasian population |
Authors: | Walpole, I.;Lee, B.;Shapiro, J.;Thomson, B.;Lipton, L.;Ananda, S.;Usatoff, V.;McLachlan, S. A.;Knowles, B.;Fox, A.;Wong, R.;Cooray, P.;Burge, M.;Clarke, K.;Pattison, S.;Nikfarjam, M.;Tebbutt, N.;Harris, M.;Nagrial, Adnan M.;Zielinski, R.;Chee, C. E.;Gibbs, P. |
WSLHD Author: | Nagrial, Adnan M. |
Subjects: | Oncology |
Issue Date: | 2023 |
Citation: | Asia-Pacific Journal of Clinical Oncology 19(1):214-225, 2023 |
Abstract: | BACKGROUND: Use of neoadjuvant (NA) chemotherapy is recommended when pancreatic ductal adenocarcinoma (PDAC) is borderline resectable METHOD: A retrospective analysis of consecutive patients with localized PDAC between January 2016 and March 2019 within the Australasian Pancreatic Cancer Registry (PURPLE, Pancreatic cancer: Understanding Routine Practice and Lifting End results) was performed. Clinicopathological characteristics, treatment, and outcome were analyzed. Overall survival (OS) comparison was performed using log-rank model and Kaplan-Meier analysis. RESULTS: The PURPLE database included 754 cases with localised PDAC, including 148 (20%) cases with borderline resectable pancreatic cancer (BRPC). Of the 148 BRPC patients, 44 (30%) underwent immediate surgery, 80 (54%) received NA chemotherapy, and 24 (16%) were inoperable. The median age of NA therapy patients was 63 years and FOLFIRINOX (53%) was more often used as NA therapy than gemcitabine/nab-paclitaxel (31%). Patients who received FOLFIRINOX were younger than those who received gemcitabine/nab-paclitaxel (60 years vs. 67 years, p = .01). Surgery was performed in 54% (43 of 80) of BRPC patients receiving NA chemotherapy, with 53% (16 of 30) achieving R0 resections. BRPC patients undergoing surgery had a median OS of 30 months, and 38% (9 of 24) achieved R0 resection. NA chemotherapy patients had a median OS of 20 months, improving to 24 months versus 10 months for patients receiving FOLFIRINOX compared to gemcitabine/nab-paclitaxel (Hazard Ratio (HR) .3, p < .0001). CONCLUSIONS: NA chemotherapy use in BRPC is increasing in Australia. One half of patients receiving NA chemotherapy proceed to curative resection, with 53% achieving R0 resections. Patients receiving Infusional 5-flurouracil, Irinotecan and Oxaliplatin (FOLIRINOX) had increased survival than gemcitabine/nab-paclitaxel. Treatment strategies are being explored in the MASTERPLAN and DYNAMIC-Pancreas trials. |
URI: | https://wslhd.intersearch.com.au/wslhdjspui/handle/1/7119 |
DOI: | https://dx.doi.org/10.1111/ajco.13807 |
Journal: | Asia-Pacific Journal of Clinical Oncology |
Type: | Journal Article |
Study or Trial: | Controlled Study Major Clinical Study Clinical Trial, Phase I Clinical Trial, Phase III Retrospective Study |
Department: | Medical Oncology |
Facility: | Westmead Blacktown |
Keywords: | Pancreatic Neoplasms Deoxycytidine Fluorouracil Carcinoma, Pancreatic Ductal |
Appears in Collections: | Blacktown Mount Druitt Hospital |
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