712P - A three-step strategy of induction chemotherapy, chemo-radiotherapy and surgery in locally advanced pancreatic cancer (LAPC) patients. Role of a no...

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Cytotoxic agents
Pancreatic Cancer
Surgical oncology
Biological therapy
Radiation oncology
Presenter Juan Fusco
Citation Annals of Oncology (2014) 25 (suppl_4): iv210-iv253. 10.1093/annonc/mdu334
Authors J.P. Fusco, J.C. Subtil, N. Buil, A. Chopitea, E. Castanon Alvarez, P. Martín, L. Arbea, L. Zubiri, F. Pardo, O.E. Carranza Rua, J. Rodriguez
  • Department Of Oncology, Clínica Universidad de Navarra, 31008 - Pamplona/ES



The optimal strategy for patients with LAPC remain a therapeutic challenge. A growing evidence suggests that both, pts with borderline resectable and unresectable tumors may benefit from a multimodal approach aimed at improving resectability and survival times. In the present work our experience after a long-term follow-up period is reported.


From December 2005 to July 2011, 67 histologically confirmed LAPC, endoscopic ultrasound (EUS) staged T3-4 and/or N+ were retrospectively analysed. They received induction gemcitabine/oxaliplatin- based chemotherapy followed, in case of radiological response or stable disease, by chemo-radiotherapy (50.4 Gy concurrently with daily capecitabine and weekly oxaliplatin). Salvage surgery was performed when technically feasible. We have applied a nonlinear mixed effects (NLME) modeling to evaluate the impact of dynamic changes in tumor size, Ca- 19.9, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio on the clinical outcome of these patients.


The median age was 63 years (range 35-85). Male to female 36/31. Thirty eight pts (57%) completed the whole program (group A), whereas 27 (40%) received chemo and radioterapy but were not elegible for surgery (Group B). Two pts (3%) progressed after induction chemotherapy (Group C). EUS staged T4 or N+ was found in 20 (30%) and 24 (36%) respectively. Toxicity profile was mild, with no grade 4 toxicity being documented. On an intent to treat basis, R0 resection rate was 57%; ypT0ypN0 were observed in 11 (29%) of patients. Among resected patients, local and distant failure rates were 5% and 55%, respectively. The liver was the most frequent site of relapse 21(43%) pts. After a median follow up of 23 months (range 4 to 102), median PFS was 21, 10 and 1 month in groups A, B and C respectively (p = <0.005). Median overall-survival was 41, 14 and 4 months in groups A, B and C respectively (p = <0.005).


Our date suggest that this three-step strategy is feasible and active in LAPC patients. The NMLE population modeling will be presented at the meeting


All authors have declared no conflicts of interest.