Use and outcomes from neoadjuvant chemotherapy in borderline resectable pancreatic ductal adenocarcinoma in an Australasian population
Corresponding Author
Imogen Walpole
Department of Medical Oncology, Northern Hospital, Victoria, Australia
Correspondence
Imogen Walpole, Northern Hospital 185 Cooper St, Epping VIC 3076, Australia.
Email: [email protected]
Search for more papers by this authorBelinda Lee
Department of Medical Oncology, Northern Hospital, Victoria, Australia
Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
Faculty of Medicine & Health Sciences, Faculty fo Medicine University of Melbourne, Victoria, Australia
Search for more papers by this authorJeremy Shapiro
Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia
Faculty of Medicine & Health Sciences, Monash University, Victoria, Australia
Search for more papers by this authorBenjamin Thomson
Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Victoria, Australia
Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
Search for more papers by this authorLara Lipton
Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia
Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
Department of Medical Oncology, Western Health, Victoria, Australia
Search for more papers by this authorSumitra Ananda
Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
Department of Medical Oncology, Western Health, Victoria, Australia
Search for more papers by this authorVal Usatoff
Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia
Department of Medical Oncology, Western Health, Victoria, Australia
Search for more papers by this authorSue-Ann Mclachlan
Faculty of Medicine & Health Sciences, Faculty fo Medicine University of Melbourne, Victoria, Australia
Department of Medical Oncology, St Vincent's Hospital, Victoria, Australia
Search for more papers by this authorBrett Knowles
Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
Department of Medical Oncology, St Vincent's Hospital, Victoria, Australia
Search for more papers by this authorAdrian Fox
Department of Medical Oncology, St Vincent's Hospital, Victoria, Australia
Department of Medical Oncology, Eastern Health, Victoria, Australia
Search for more papers by this authorRachel Wong
Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
Faculty of Medicine & Health Sciences, Monash University, Victoria, Australia
Department of Medical Oncology, Eastern Health, Victoria, Australia
Department of Medical Oncology, Epworth Hospital, Victoria, Australia
Search for more papers by this authorPrasad Cooray
Department of Medical Oncology, Knox Private Hospital, Victoria, Australia
Search for more papers by this authorMatthew Burge
Department of Medical Oncology, Royal Brisbane Hospital, Queensland, Australia
Search for more papers by this authorKate Clarke
Department of Medical Oncology, Wellington Hospital, Wellington, New Zealand
Search for more papers by this authorSharon Pattison
Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Search for more papers by this authorMehrdad Nikfarjam
Faculty of Medicine & Health Sciences, Faculty fo Medicine University of Melbourne, Victoria, Australia
Department of Medical Oncology, Austin Health, Victoria, Australia
Department of Surgery, Warringal Private Hospital, Victoria, Australia
Search for more papers by this authorNiall Tebbutt
Department of Medical Oncology, Austin Health, Victoria, Australia
Search for more papers by this authorMarion Harris
Department of Medical Oncology, Monash Medical Centre, Victoria, Australia
Search for more papers by this authorAdnan Nagrial
Department of Medical Oncology, Westmead Hospital, New South Wales, Australia
Search for more papers by this authorRob Zielinski
Department of Medical Oncology, Orange Hospital, New South Wales, Australia
Department of Medical Oncology, Dubbo Base Hospital, New South Wales, Australia
Department of Medical Oncology, Bathurst Base Hospital, New South Wales, Australia
Search for more papers by this authorCheng Ean Chee
Department of Medical Oncology, National University Cancer Institute, Singapore
Search for more papers by this authorPeter Gibbs
Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
Faculty of Medicine & Health Sciences, Faculty fo Medicine University of Melbourne, Victoria, Australia
Search for more papers by this authorCorresponding Author
Imogen Walpole
Department of Medical Oncology, Northern Hospital, Victoria, Australia
Correspondence
Imogen Walpole, Northern Hospital 185 Cooper St, Epping VIC 3076, Australia.
Email: [email protected]
Search for more papers by this authorBelinda Lee
Department of Medical Oncology, Northern Hospital, Victoria, Australia
Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
Faculty of Medicine & Health Sciences, Faculty fo Medicine University of Melbourne, Victoria, Australia
Search for more papers by this authorJeremy Shapiro
Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia
Faculty of Medicine & Health Sciences, Monash University, Victoria, Australia
Search for more papers by this authorBenjamin Thomson
Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Victoria, Australia
Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
Search for more papers by this authorLara Lipton
Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia
Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
Department of Medical Oncology, Western Health, Victoria, Australia
Search for more papers by this authorSumitra Ananda
Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
Department of Medical Oncology, Western Health, Victoria, Australia
Search for more papers by this authorVal Usatoff
Department of Medical Oncology, Cabrini Health, Malvern, Victoria, Australia
Department of Medical Oncology, Western Health, Victoria, Australia
Search for more papers by this authorSue-Ann Mclachlan
Faculty of Medicine & Health Sciences, Faculty fo Medicine University of Melbourne, Victoria, Australia
Department of Medical Oncology, St Vincent's Hospital, Victoria, Australia
Search for more papers by this authorBrett Knowles
Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
Department of Medical Oncology, St Vincent's Hospital, Victoria, Australia
Search for more papers by this authorAdrian Fox
Department of Medical Oncology, St Vincent's Hospital, Victoria, Australia
Department of Medical Oncology, Eastern Health, Victoria, Australia
Search for more papers by this authorRachel Wong
Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
Faculty of Medicine & Health Sciences, Monash University, Victoria, Australia
Department of Medical Oncology, Eastern Health, Victoria, Australia
Department of Medical Oncology, Epworth Hospital, Victoria, Australia
Search for more papers by this authorPrasad Cooray
Department of Medical Oncology, Knox Private Hospital, Victoria, Australia
Search for more papers by this authorMatthew Burge
Department of Medical Oncology, Royal Brisbane Hospital, Queensland, Australia
Search for more papers by this authorKate Clarke
Department of Medical Oncology, Wellington Hospital, Wellington, New Zealand
Search for more papers by this authorSharon Pattison
Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Search for more papers by this authorMehrdad Nikfarjam
Faculty of Medicine & Health Sciences, Faculty fo Medicine University of Melbourne, Victoria, Australia
Department of Medical Oncology, Austin Health, Victoria, Australia
Department of Surgery, Warringal Private Hospital, Victoria, Australia
Search for more papers by this authorNiall Tebbutt
Department of Medical Oncology, Austin Health, Victoria, Australia
Search for more papers by this authorMarion Harris
Department of Medical Oncology, Monash Medical Centre, Victoria, Australia
Search for more papers by this authorAdnan Nagrial
Department of Medical Oncology, Westmead Hospital, New South Wales, Australia
Search for more papers by this authorRob Zielinski
Department of Medical Oncology, Orange Hospital, New South Wales, Australia
Department of Medical Oncology, Dubbo Base Hospital, New South Wales, Australia
Department of Medical Oncology, Bathurst Base Hospital, New South Wales, Australia
Search for more papers by this authorCheng Ean Chee
Department of Medical Oncology, National University Cancer Institute, Singapore
Search for more papers by this authorPeter Gibbs
Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
Faculty of Medicine & Health Sciences, Faculty fo Medicine University of Melbourne, Victoria, Australia
Search for more papers by this authorAbstract
Background
Use of neoadjuvant (NA) chemotherapy is recommended when pancreatic ductal adenocarcinoma (PDAC) is borderline resectable
Method
A retrospective analysis of consecutive patients with localized PDAC between January 2016 and March 2019 within the Australasian Pancreatic Cancer Registry (PURPLE, Pancreatic cancer: Understanding Routine Practice and Lifting End results) was performed. Clinicopathological characteristics, treatment, and outcome were analyzed. Overall survival (OS) comparison was performed using log-rank model and Kaplan–Meier analysis.
Results
The PURPLE database included 754 cases with localised PDAC, including 148 (20%) cases with borderline resectable pancreatic cancer (BRPC). Of the 148 BRPC patients, 44 (30%) underwent immediate surgery, 80 (54%) received NA chemotherapy, and 24 (16%) were inoperable. The median age of NA therapy patients was 63 years and FOLFIRINOX (53%) was more often used as NA therapy than gemcitabine/nab-paclitaxel (31%). Patients who received FOLFIRINOX were younger than those who received gemcitabine/nab-paclitaxel (60 years vs. 67 years, p = .01). Surgery was performed in 54% (43 of 80) of BRPC patients receiving NA chemotherapy, with 53% (16 of 30) achieving R0 resections. BRPC patients undergoing surgery had a median OS of 30 months, and 38% (9 of 24) achieved R0 resection. NA chemotherapy patients had a median OS of 20 months, improving to 24 months versus 10 months for patients receiving FOLFIRINOX compared to gemcitabine/nab-paclitaxel (Hazard Ratio (HR) .3, p < .0001).
Conclusions
NA chemotherapy use in BRPC is increasing in Australia. One half of patients receiving NA chemotherapy proceed to curative resection, with 53% achieving R0 resections. Patients receiving Infusional 5-flurouracil, Irinotecan and Oxaliplatin (FOLIRINOX) had increased survival than gemcitabine/nab-paclitaxel. Treatment strategies are being explored in the MASTERPLAN and DYNAMIC-Pancreas trials.
CONFLICTS OF INTEREST
No conflicts of interest to declare.
Open Research
DATA AVAILABILITY STATEMENT
Data available on request from the authors.
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