Detailed Abstract
[E-poster - Biliary & Pancreas (Pancreas Disease/Surgery)]
[EP 126] Switching Chemotherapy In Neoadjuvant Treatment For Resectable/borderline Resectable Pancreatic Cancer - New Treatment Strategy In The Era Of Biological Borderline Resectable-
Daisuke HASHIMOTO*1 , Sohei SATOI1 , Tomohisa YAMAMOTO1 , So YAMAKI1 , Hidetaka MIYAZAKI1 , Yuki MATSUI1 , Yuki TSYBULSKYI1 , Mitsugu SEKIMOTO1
1 Department Of Surgery, Kansai Medical University, JAPAN
Background : The best timing of surgery after neoadjuvant therapy (NAT) for resectable (R)/ borderline resectable (BR)- pancreatic ductal adenocarcinoma (PDAC) has been still controversial. Recently, the idea of biological BR based on CA19-9 as a population with poor prognosis among radiological R has been proposed. We are introducing switching chemotherapy targeting CA19-9 in NAT. This does not limit the duration of NAT, but rather continues NAT until CA19-9 declines, after which surgery is performed. The objective of this study was to investigate the effect of switching chemotherapy in NAT for R/BR-PDAC, regarding biological BR.
Methods : In this single center retrospective study, 226 patients with R/BR-PDAC underwent NAT from 2010 to 2021 were included. Anatomical R-PDAC with CA19-9 greater than 150 IU/ml was defined as biological BR in this study.
Results : Anatomically, 143 patients (63%) were R-PDAC, 49 (22%) were BR-A, and 34 (15%) were BR-PV. The first-line of NAT was gemcitabine (GEM) + S-1 in 164 patients (73%), GEM+ nab-Paclitaxel in 29 (13%), S-1(+ radiation therapy) in 26 (12%), and FOLFIRINOX in 7 (3%). Pancreatic resection was performed in 206 patients (91%), whereas 20 (9%) did not receive it. Median survival time (MST) was 38.3 months in the total cohort, and 41.9 months in the resected group and 18.4 months in the un-resected group, respectively (p<0.001). Of the anatomical R, 71 patients (31%) were Biological BR. When Biological BR is considered, MST in the new BR group (n=154, Biological BR, BR-A, and BR-PV) was shorter than that in the R group (n=72), although there was no significant difference (46.9 months vs 36.4 months, p=0.225). In the new BR group, 26 patients (17%) received switching chemotherapy to achieve a CA19-9 of less than 150 IU/ml. The patients who were able to achieve a CA19-9 of less than 150 IU/ml after switching chemotherapy (n=18, MST 63.8 months) showed similar MST as those who were able to achieve a CA19-9 of less than 150 IU/ml without switching chemotherapy (n=72, MST 83.8 months, p=0.546), and significantly better MST in those who did not archive a CA19-9 of less than 150 IU/ml without switching chemotherapy (n=56, MST 25.7 months, p=0.033). Disease free survival analysis similarly showed the benefit of switching chemotherapy.
Conclusions : Although it needs to be verified in the future studies including more patients, implementation of the switching chemotherapy targeting CA19-9 regarding Biological BR may improve prognosis in NAT for R/BR-PDAC.
Methods : In this single center retrospective study, 226 patients with R/BR-PDAC underwent NAT from 2010 to 2021 were included. Anatomical R-PDAC with CA19-9 greater than 150 IU/ml was defined as biological BR in this study.
Results : Anatomically, 143 patients (63%) were R-PDAC, 49 (22%) were BR-A, and 34 (15%) were BR-PV. The first-line of NAT was gemcitabine (GEM) + S-1 in 164 patients (73%), GEM+ nab-Paclitaxel in 29 (13%), S-1(+ radiation therapy) in 26 (12%), and FOLFIRINOX in 7 (3%). Pancreatic resection was performed in 206 patients (91%), whereas 20 (9%) did not receive it. Median survival time (MST) was 38.3 months in the total cohort, and 41.9 months in the resected group and 18.4 months in the un-resected group, respectively (p<0.001). Of the anatomical R, 71 patients (31%) were Biological BR. When Biological BR is considered, MST in the new BR group (n=154, Biological BR, BR-A, and BR-PV) was shorter than that in the R group (n=72), although there was no significant difference (46.9 months vs 36.4 months, p=0.225). In the new BR group, 26 patients (17%) received switching chemotherapy to achieve a CA19-9 of less than 150 IU/ml. The patients who were able to achieve a CA19-9 of less than 150 IU/ml after switching chemotherapy (n=18, MST 63.8 months) showed similar MST as those who were able to achieve a CA19-9 of less than 150 IU/ml without switching chemotherapy (n=72, MST 83.8 months, p=0.546), and significantly better MST in those who did not archive a CA19-9 of less than 150 IU/ml without switching chemotherapy (n=56, MST 25.7 months, p=0.033). Disease free survival analysis similarly showed the benefit of switching chemotherapy.
Conclusions : Although it needs to be verified in the future studies including more patients, implementation of the switching chemotherapy targeting CA19-9 regarding Biological BR may improve prognosis in NAT for R/BR-PDAC.
SESSION
E-poster
E-Session 03/23 ~ 03/25 ALL DAY