Abstract 1565P
Background
One third of pancreatic cancers (PC) are borderline-resectable (BL) or locally advanced (LA). Even in the absence of metastases, prognosis is poor. There is a lack of prospective data supporting the best approach for these tumors.
Methods
This is a retrospective analysis of a series of consecutive patients diagnosed for localized pancreatic adenocarcinoma in a single academic center, who were staged as BL or LA after discussion in the weekly multidisciplinary board (MDB). All these patients received neoadjuvant chemotherapy (ChT), followed by chemoradiation (ChRT) in some cases, and those achieving enough downstaging had a curative-intent surgery. Descriptive data on the patient’s characteristics, neoadjuvant treatments, toxicities, curative resections, postoperative complications, pathology reports and adjuvant treatment are presented. Overall survival (OS) and disease-free survival (in the group of resected patients) was calculated with the Kaplan-Meier method and log-rank test.
Results
Between August 2011 and July 2019, 49 patients fulfilled the inclusion criteria and all received neoadjuvant ChT, FOLFIRINOX being the most frequent scheme (77%). 11 patients (22,4%) had the ChT dose reduced from the beginning and 23 (47%) required a dose-reduction on the course of treatment due to toxicity. The most prevalent grade 3 or 4 toxicities were neutropenia (26,5%), neurotoxicity (12,2%), diarrhea (8,2%), nausea (8,2%) and asthenia (6,3%). Only 18 patients (36,7%) received ChRT. 22 patients (44,9%) shifted to potentially resectable, 2 of whom refused surgery. A R0 or R1 pancreatic resection was performed in 19 and one underwent exploratory laparotomy. 9 patients (47,3%) required a vascular resection, mostly involving the superior mesenteric vein. The median OS of the whole cohort was 23,6 months (95% CI 15,03 – 32,17): 29,8 months for resected and 12,4 months for non-resected patients, respectively (p=0.002).
Conclusions
A neoadjuvant approach of ChT +/- ChRT in BL and LAPC was well tolerated and permitted a curative resection in 38,8% of the patients with potential improvement on OS.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
A. Cervantes: Research grant/Funding (institution): Genentech; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Merck Serono; Research grant/Funding (institution): BMS; Research grant/Funding (institution): MSD; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Roche; Research grant/Funding (institution): Beigene; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Bayer; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Servier; Research grant/Funding (institution): Lilly; Research grant/Funding (institution): Novartis; Research grant/Funding (institution): Takeda; Research grant/Funding (institution): Astellas; Research grant/Funding (institution): Fibrogen; Advisory/Consultancy, Speaker Bureau/Expert testimony: Pierre Fabre. All other authors have declared no conflicts of interest.