Long-term survival benefit of upfront chemotherapy in patients with newly diagnosed borderline resectable pancreatic cancer
Bikram Shrestha
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
These two authors contributed equally and are considered to be co-first authors.Search for more papers by this authorYifei Sun
Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
These two authors contributed equally and are considered to be co-first authors.Search for more papers by this authorFarzana Faisal
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorVictoria Kim
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorKevin Soares
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorAlex Blair
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorJoseph M. Herman
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas
Search for more papers by this authorAmol Narang
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorAvani S. Dholakia
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorLauren Rosati
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorAmy Hacker-Prietz
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorLinda Chen
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorDaniel A. Laheru
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorAna De Jesus-Acosta
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorDung T. Le
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorRoss Donehower
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorNilofar Azad
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorLuis A. Diaz
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorAdrian Murphy
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorValerie Lee
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorElliot K. Fishman
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorRalph H. Hruban
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorTingbo Liang
The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
Search for more papers by this authorJohn L. Cameron
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorMartin Makary
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorMatthew J. Weiss
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorNita Ahuja
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorJin He
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorChristopher L. Wolfgang
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorChiung-Yu Huang
Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
These three authors contributed equally and are considered to be co-senior authors.Search for more papers by this authorCorresponding Author
Lei Zheng
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
These three authors contributed equally and are considered to be co-senior authors.Correspondence
Lei Zheng, Department of Oncology, The Johns Hopkins University School of Medicine, 1650 Orleans Street, CRB1 Room 488, Baltimore, MD 21287. Tel: 410-502-6241; Fax: 410-614-8216; E-mail: [email protected]
Search for more papers by this authorBikram Shrestha
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
These two authors contributed equally and are considered to be co-first authors.Search for more papers by this authorYifei Sun
Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
These two authors contributed equally and are considered to be co-first authors.Search for more papers by this authorFarzana Faisal
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorVictoria Kim
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorKevin Soares
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorAlex Blair
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorJoseph M. Herman
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas
Search for more papers by this authorAmol Narang
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorAvani S. Dholakia
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorLauren Rosati
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorAmy Hacker-Prietz
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorLinda Chen
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorDaniel A. Laheru
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorAna De Jesus-Acosta
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorDung T. Le
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorRoss Donehower
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorNilofar Azad
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorLuis A. Diaz
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorAdrian Murphy
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorValerie Lee
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorElliot K. Fishman
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorRalph H. Hruban
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorTingbo Liang
The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
Search for more papers by this authorJohn L. Cameron
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorMartin Makary
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorMatthew J. Weiss
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorNita Ahuja
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorJin He
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorChristopher L. Wolfgang
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorChiung-Yu Huang
Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
These three authors contributed equally and are considered to be co-senior authors.Search for more papers by this authorCorresponding Author
Lei Zheng
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
These three authors contributed equally and are considered to be co-senior authors.Correspondence
Lei Zheng, Department of Oncology, The Johns Hopkins University School of Medicine, 1650 Orleans Street, CRB1 Room 488, Baltimore, MD 21287. Tel: 410-502-6241; Fax: 410-614-8216; E-mail: [email protected]
Search for more papers by this authorAbstract
The use of neoadjuvant chemotherapy or radiation for borderline resectable pancreatic adenocarcinoma (BL-PDAC) is increasing. However, the impact of neoadjuvant chemotherapy and radiation therapy on the outcome of BL-PDAC remains to be elucidated. We performed a retrospective analysis of 93 consecutive patients who were diagnosed with BL-PDAC and primarily followed at Johns Hopkins Hospital between February 2007 and December 2012. Among 93 patients, 62% received upfront neoadjuvant chemotherapy followed by chemoradiation, whereas 20% received neoadjuvant chemoradiation alone and 15% neoadjuvant chemotherapy alone. Resectability following all neoadjuvant therapy was 44%. Patients who underwent resection with a curative intent had a median overall survival (mOS) of 25.8 months, whereas those who did not undergo surgery had a mOS of 11.9 months. However, resectability and overall survival were not significantly different between the three types of neoadjuvant therapy. Nevertheless, 22% (95% CI, 0.13–0.36) of the 58 patients who received upfront chemotherapy followed by chemoradiation remained alive for a minimum of 48 months compared to none of the 19 patients who received upfront chemoradiation. Among patients who underwent curative surgical resection, 32% (95% CI, 0.19–0.55) of those who received upfront chemotherapy remained disease free at least 48 months following surgical resection, whereas none of the eight patients who received upfront chemoradiation remained disease free beyond 24 months following surgical resection. Neoadjuvant therapy with upfront chemotherapy may result in long-term survival in a subpopulation of patients with BL-PDAC.
Supporting Information
| Filename | Description |
|---|---|
| cam41104-sup-0001-TableS1-S4.pdfPDF document, 398.5 KB |
Table S1. Univariate logistic regression analysis of factors affecting probability of resectability. Table S2. Univariate Cox regression analysis of factors affecting progression-free survival among patients who did not undergo surgery. Table S3. Univariate Cox regression analysis of factors associated with overall survival. Table S4. Univariate analysis of factors associated with recurrence-free survival among patients who underwent curative surgical resection. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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