P-183 - Neoadjuvant treatment in borderline resectable pancreatic adenocarcinoma (PA): A single center series

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Pancreatic Cancer
Presenter H. Verdaguer Mata
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors H. Verdaguer Mata1, Ò. Serra2, M. Calvo3, F.J. Pérez Martín4, M. Galán3, B. Laquente5, J. Busquets1, N. Pelaez1, L. Secanella1, D. Leiva1, S. Ruiz1, I. Peiro1, R. Lopez Urdiales1, T. Serrano1, S. Vazquez6, M. Cambray1, C. Sanchez1, J. Fabregat1
  • 1Institut Català d'Oncologia, Hospitalet del Llobregat/ES
  • 2Insitut Català d'Oncologia, Hospitalet del Llobregat, Llobregat/ES
  • 3Interdisciplinary Committee Of Esophagogastric Tumours, Institut Català D'oncologia (ico), Hospitalet de Llobregat, Llobregat/ES
  • 4Clinical Research Unit, Institut Català d'Oncologia (ICO), Barcelona/ES
  • 5Laboratori De Recerca Translacional And 2 Servei D'oncologia Mèdica, Institut Català d'Oncologia, Hospital Duran i Reynals, IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), Barcelona/ES
  • 6Hospital Duran i Reynals, Barcelona/ES

Abstract

Introduction

Borderline resectable PA may benefit from resection when preceded by neoadjuvant therapy.

Methods

We evaluated 22 consecutive patients (pts) with cytology confirmed PA. Borderline resectability was evaluated by multidisciplinary team.

Most pts received 6 cycles of gemcitabine 1 g/m2 iv on day 1 and oxaliplatin 100 mg/m2 (GEMOX) day 2 every two weeks. Six pts received the same chemotherapy (CT) schedule plus erlotinib in the context of clinical trial. After re-staging with multidetector computer tomography (MDTC), pts without progressive disease received 5 weeks therapy with 250 mg/m2/d 5-FU infusion and concomitant radiotherapy (50.4 Gy). Pts treated in clinical trial received gemcitabine 40 mg/m2 twice a week and erlotinib 100 mg/d during radiotherapy treatment. After new re-staging with MDTC, pts that did not progress underwent surgical resection.

Results

Median follow up for all pts was 12.8 mo. Median age was 63 (range 41-78). After nutritional status evaluation 86.4% had malnutrition. Three pts had performance status (PS) 0 and 19 pts (86.4%) had PS1. Symptoms at diagnosis were jaundice with biliary stent replacement (90%), asthenia (54%), abdominal pain (54.5%) and anorexia (41%). Grade 3 or 4 toxicities were nausea/emesis (n =1) and hematologic (n = 5). Induction CT was completed in 90% of pts. Disease progression precluded surgery in 9 of the pts (40%). Eleven pts (50%) underwent pancreatectomy. Seven of the resected tumors (32%) had negative margins. Only one tumor was node positive and there were 3 complete pathological responses. There were no in-hospital or 30-day mortalities. Four pts needed re-operation. Of the 11 pts who completed all therapy, 4 are alive, including 1 who has no evidence of disease. The median overall survival (OS) for all pts was 14 mo (95% CI 9.29-18.7). Median OS for pts who underwent surgery was 30.4 mo (95%CI 14.4-46.3) and 10.9 mo (95% CI 7.8-13.9) for those pts no candidate to surgery (p < 0.0001).

Conclusion

GEMOX based CT followed by chemoradiation as neoadjuvant therapy for borderline resectable PA is safe, and our experience suggests favorable resection rates and survival benefit compared with previous reports in this high-risk patient population.