First-Line Gemcitabine and Nab-Paclitaxel Chemotherapy for Localized Pancreatic Ductal Adenocarcinoma

Journal Article · Fri Feb 15 04:00:00 EST 2019 · Annals of Surgical Oncology (Online)

DOI:https://doi.org/10.1245/S10434-018-6807-9· OSTI ID:22927892

Gulhati, Pat ^[1]; Prakash, Laura; Katz, Matthew H. G. ^[2]; Wang, Xuemei ^[3]; Javle, Milind; Shroff, Rachna; Fogelman, David ^[4]; Lee, Jeffrey E.; Tzeng, Ching-Wei D. ^[2]; Lee, Jeffrey H.; Weston, Brian ^[5]; Tamm, Eric; Bhosale, Priya ^[6]; Koay, Eugene J. ^[7]; Maitra, Anirban; Wang, Huamin ^[8]; Wolff, Robert A.

---

1. The University of Texas MD Anderson Cancer Center, Hematology/Oncology Fellowship Program, Division of Cancer Medicine (United States)
2. The University of Texas MD Anderson Cancer Center, Division of Surgery, Department of Surgical Oncology (United States)
3. The University of Texas MD Anderson Cancer Center, Department of Biostatistics (United States)
4. The University of Texas MD Anderson Cancer Center, Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology (United States)
5. The University of Texas MD Anderson Cancer Center, Division of Internal Medicine, Department of Gastroenterology (United States)
6. The University of Texas MD Anderson Cancer Center, Division of Diagnostic Imaging, Department of Diagnostic Radiology (United States)
7. The University of Texas MD Anderson Cancer Center, Division of Radiation Oncology, Department of Radiation Oncology (United States)
8. The University of Texas MD Anderson Cancer Center, Division of Pathology/Lab Medicine, Department of Anatomic Pathology (United States)

Background: Preoperative chemotherapy provides early treatment of micro-metastases and guaranteed delivery of all components of multimodality therapy for localized pancreatic ductal adenocarcinoma (PDAC). For locally advanced (LA) PDAC, induction chemotherapy is the standard of care. This study evaluated the use of gemcitabine and nab-paclitaxel (Gem/nab-P) as first-line therapy for localized PDAC. Methods: Clinicopathologic features, treatment, and outcomes were evaluated for 99 patients with localized PDAC. The patients were staged using previously published criteria as follows: potentially resectable (PR), borderline type A (BR-A) (anatomy amenable to vascular resection), BR-B (biology suspicious for metastatic disease including high CA19-9), BR–C (comorbidities requiring medical optimization), and LA. Results: The 99 patients (PR/BR/LA: 45/14/40) were treated with Gem/nab-P. Clinical staging showed that 20 patients had PR or BR-A disease, whereas 39 patients had BR-B or BR-C disease. The BR-B+C cases included one or more of the following: age of 80 years or older (13%), Eastern Cooperative Oncology Group performance status (ECOG PS) of 2 or more (13%), moderate to severe comorbidities (55%), CA19-9 of 1000 or higher (28%), and suspicion for metastases (21%). The majority of the patients received biweekly Gem/nab-P dosing, which was well tolerated. Pancreatectomy was performed for 12 (60%) of 20 patients with PR+BR-A, 2 (5%) of 39 patients with BR-B+C, and 1 (3%) of 40 patients with LA disease. During a median follow-up period of 26 months, the median overall survival (OS) period was 18 months (95% confidence interval [CI], 15.6–20.5 months) for all the patients, 17 months (95% CI, 14.6–19.5 months) for the unresected patients, and not reached for the resected patients (p = 0.028 for resected vs unresected patients). Conclusions: A significant number of patients with radiographically resectable PDAC albeit aggressive biology (BR-B), medically inoperable conditions (BR-C), or both received biweekly first-line Gem/nab-P. The resection rates were lower for the BR-B/BR-C patients than for the PR/BR-A patients (hazard ratio [HR], 0.43; 95% CI, 0.19–1.00; p = 0.05).

• OSTI ID: 22927892
• Journal Information: Annals of Surgical Oncology (Online), Journal Name: Annals of Surgical Oncology (Online) Journal Issue: 2 Vol. 26; ISSN 1534-4681
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANATOMY
CARCINOMAS
CHEMOTHERAPY
METASTASES
PANCREAS
PATIENTS