Use and outcomes from neoadjuvant chemotherapy in borderline resectable pancreatic ductal adenocarcinoma in an Australasian population

Imogen Walpole; Belinda Lee; Jeremy Shapiro; Benjamin Thomson; Lara Lipton; Sumitra Ananda; Val Usatoff; Sue-Ann Mclachlan; Brett Knowles; Adrian Fox; Rachel Wong; Prasad Cooray; Matthew Burge; Kate Clarke; Sharon Pattison; Mehrdad Nikfarjam; Niall Tebbutt; Marion Harris; Adnan Nagrial; Rob Zielinski; Cheng Ean Chee; Peter Gibbs

doi:10.1111/ajco.13807

Use and outcomes from neoadjuvant chemotherapy in borderline resectable pancreatic ductal adenocarcinoma in an Australasian population

Asia Pac J Clin Oncol. 2023 Feb;19(1):214-225. doi: 10.1111/ajco.13807. Epub 2022 Jul 13.

Authors

Imogen Walpole¹, Belinda Lee^{1

2

3}, Jeremy Shapiro^{4

5}, Benjamin Thomson^{6

7}, Lara Lipton^{4

7

8}, Sumitra Ananda^{7

8}, Val Usatoff^{4

8}, Sue-Ann Mclachlan^{3

9}, Brett Knowles^{7

9}, Adrian Fox^{9

10}, Rachel Wong^{2

5

10

11}, Prasad Cooray¹², Matthew Burge¹³, Kate Clarke¹⁴, Sharon Pattison¹⁵, Mehrdad Nikfarjam^{3

16

17}, Niall Tebbutt¹⁶, Marion Harris¹⁸, Adnan Nagrial¹⁹, Rob Zielinski^{20

21

22}, Cheng Ean Chee²³, Peter Gibbs^{2

3}

Affiliations

¹ Department of Medical Oncology, Northern Hospital, Victoria, Australia.
² Walter and Eliza Hall Institute, Melbourne, Victoria, Australia.
³ Faculty of Medicine & Health Sciences, Faculty fo Medicine University of Melbourne, Victoria, Australia.
⁴ Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia.
⁵ Faculty of Medicine & Health Sciences, Monash University, Victoria, Australia.
⁶ Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Victoria, Australia.
⁷ Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia.
⁸ Department of Medical Oncology, Western Health, Victoria, Australia.
⁹ Department of Medical Oncology, St Vincent's Hospital, Victoria, Australia.
¹⁰ Department of Medical Oncology, Eastern Health, Victoria, Australia.
¹¹ Department of Medical Oncology, Epworth Hospital, Victoria, Australia.
¹² Department of Medical Oncology, Knox Private Hospital, Victoria, Australia.
¹³ Department of Medical Oncology, Royal Brisbane Hospital, Queensland, Australia.
¹⁴ Department of Medical Oncology, Wellington Hospital, Wellington, New Zealand.
¹⁵ Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
¹⁶ Department of Medical Oncology, Austin Health, Victoria, Australia.
¹⁷ Department of Surgery, Warringal Private Hospital, Victoria, Australia.
¹⁸ Department of Medical Oncology, Monash Medical Centre, Victoria, Australia.
¹⁹ Department of Medical Oncology, Westmead Hospital, New South Wales, Australia.
²⁰ Department of Medical Oncology, Orange Hospital, New South Wales, Australia.
²¹ Department of Medical Oncology, Dubbo Base Hospital, New South Wales, Australia.
²² Department of Medical Oncology, Bathurst Base Hospital, New South Wales, Australia.
²³ Department of Medical Oncology, National University Cancer Institute, Singapore.

PMID: 35831999
DOI: 10.1111/ajco.13807

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.

Keywords: drug therapy; general surgery; mortality; neoadjuvant therapy; pancreatic neoplasms.

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / adverse effects
Carcinoma, Pancreatic Ductal* / drug therapy
Carcinoma, Pancreatic Ductal* / pathology
Carcinoma, Pancreatic Ductal* / surgery
Deoxycytidine
Fluorouracil
Gemcitabine
Humans
Leucovorin
Middle Aged
Neoadjuvant Therapy / methods
Pancreatic Neoplasms* / drug therapy
Pancreatic Neoplasms* / pathology
Pancreatic Neoplasms* / surgery
Retrospective Studies

Substances

Gemcitabine
Deoxycytidine
Fluorouracil
Leucovorin

Abstract

MeSH terms

Substances

Grants and funding