Radiographic and Serologic Predictors of Pathologic Major Response to Preoperative Therapy for Pancreatic Cancer

Published on Apr 1, 2021in Annals of Surgery12.969
· DOI :10.1097/SLA.0000000000003442
Sources
Abstract
OBJECTIVE: We sought to identify potential radiologic and serologic markers of pancreatic tumor response to therapy, using pathologic major response (pMR) as the objective endpoint. BACKGROUND: We previously demonstrated that a pMR to preoperative therapy, defined as detection of <5% viable cancer cells in the surgical specimen on histopathological analysis, is an important prognostic factor for patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: Pretreatment and posttreatment computed tomography scans of consecutive patients who received preoperative chemotherapy and/or (chemo)radiation before pancreatectomy for PDAC between January 2010 and December 2018 were rereviewed. Response per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, other radiographic changes in tumor size and anatomic extent, and posttreatment CA 19-9 levels were compared between patients who did and did not have a pMR on final histopathologic analysis of their surgical specimens. RESULTS: A total of 290 patients with localized PDAC underwent pancreatectomy between 2010 and 2018 after receiving preoperative chemotherapy (n = 36; 12%), (chemo)radiation (n = 87; 30%), or both (n = 167; 58%). Among them, 28 (10%) experienced pMR, including 9 (3.1%) who experienced pathologic complete response. On multivariable logistic regression, low posttreatment CA 19-9 level, RECIST partial response, and reduction in tumor volume were confirmed to be independently associated with pMR (P < 0.01). CONCLUSIONS: We identified serologic and radiographic indicators of pMR that could help inform the delivery of preoperative therapy to patients with PDAC.
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References26
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Jan 1, 2019·Gastroenterology22.68
#1Vincent Bernard (University of Texas MD Anderson Cancer Center)H-Index: 13
#2D. U. Kim (University of Texas MD Anderson Cancer Center)H-Index: 5
Last. Paola A. Guerrero (University of Texas MD Anderson Cancer Center)H-Index: 10
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Background & Aims We aimed to investigate the clinical utility of circulating tumor cell DNA (ctDNA) and exosome DNA (exoDNA) in pancreatic cancer. Methods We collected liquid biopsy samples from 194 patients undergoing treatment for localized or metastatic pancreatic adenocarcinoma from April 7, 2015, through October 13, 2017 (425 blood samples collected before [baseline] and during therapy). Additional liquid biopsy samples were collected from 37 disease control individuals. Droplet digital po...
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Dec 19, 2018·The New England Journal of Medicine91.25
#1Thierry ConroyH-Index: 52
#2Pascal HammelH-Index: 87
Last. James Joseph Biagi (University of Lorraine)H-Index: 19
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Abstract Background Among patients with metastatic pancreatic cancer, combination chemotherapy with fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) leads to longer overall surviv...
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Jul 1, 2018·Annals of Surgery12.97
#1Jin He (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 45
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Objectives:To describe the survival outcome of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (BR/LA-PDAC) who have a pathologic complete response (pCR) following neoadjuvant chemoradiation.Background:Patients with BR/LA-PDAC are often treated with neoadjuva
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Apr 20, 2018·European Radiology5.32
#1Giovanni MarchegianiH-Index: 32
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Objectives To assess factors associated with radical resection (R0) of pancreatic ductal adenocarcinoma (PDAC) after induction treatment with FOLFIRINOX.
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Apr 18, 2018·Radiology11.11
#1Marc ZinsH-Index: 28
#2Celso MatosH-Index: 42
Last. Christophe CassinottoH-Index: 17
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The objective of this article is to define the main goals of initial pancreatic ductal adenocarcinoma (PDA) staging and to review the main results and limitations of the different imaging techniques at this time point. The scientific rationale for neoadjuvant therapy in patients with nonmetastatic PDA is detailed. The challenges raised by assessing the imaging-study response to neoadjuvant therapy are discussed.
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Apr 15, 2018·Cancer6.86
#7Jordan M. Cloyd (University of Texas MD Anderson Cancer Center)H-Index: 22
BACKGROUND: The assessment of pancreatic ductal adenocarcinoma (PDAC) response to therapy remains challenging. The objective of this study was to investigate whether changes in the tumor/parenchyma interface are associated with response. METHODS: Computed tomography (CT) scans before and after therapy were reviewed in 4 cohorts: cohort 1 (99 patients with stage I/II PDAC who received neoadjuvant chemoradiation and surgery); cohort 2 (86 patients with stage IV PDAC who received chemotherapy), coh...
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Nov 1, 2017·JAMA Surgery14.77
#1Jordan M. Cloyd (University of Texas MD Anderson Cancer Center)H-Index: 22
Importance We previously demonstrated that a major pathologic response to preoperative therapy, defined histopathologically by the presence of less than 5% viable cancer cells in the surgical specimen, is an important prognostic factor for patients with pancreatic ductal adenocarcinoma. However, to our knowledge, the patients most likely to experience a significant response to therapy are undefined. Objective To identify clinical factors associated with major pathologic response in a large cohor...
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Mar 1, 2017·Journal of Surgical Oncology3.45
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#2Baojin Fu (UC: University of Cincinnati)H-Index: 1
Last. Syed A. Ahmad (UC: University of Cincinnati)H-Index: 58
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BACKGROUND AND OBJECTIVES In patients with borderline resectable pancreas cancers, clinicians frequently consider radiographic response as the primary driver of whether patients should be offered surgical intervention following neoadjuvant therapy (NT). We sought to determine any correlation between radiographic and pathologic response rates following NT. METHODS Between 2005 and 2015, 38 patients at a tertiary care referral center underwent NT followed by pancreaticoduodenectomy for borderline ...
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Dec 1, 2016·The American Journal of Surgical Pathology6.39
#1Sun Mi Lee (University of Texas MD Anderson Cancer Center)H-Index: 1
#2Matthew H.G. KatzH-Index: 69
Last. Huamin WangH-Index: 85
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Neoadjuvant therapy has been increasingly used to treat patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC). Although the College of American Pathologists (CAP) grading scheme for tumor response in posttherapy specimens has been used, its clinical significance has not been v
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Aug 1, 2016·JAMA Surgery14.77
#7Lawrence Schwartz (Columbia University)H-Index: 51
Importance Although consensus statements support the preoperative treatment of borderline resectable pancreatic cancer, no prospective, quality-controlled, multicenter studies of this strategy have been conducted. Existing studies are retrospective and confounded by heterogeneity in patients studied, therapeutic algorithms used, and outcomes reported. Objective To determine the feasibility of conducting studies of multimodality therapy for borderline resectable pancreatic cancer in the cooperati...
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123
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This study aimed to assess the impact of neoadjuvant therapy (NAT) for borderline resectable or locally advanced pancreatic cancer (BR/LAPC) on the American Joint Commission on Cancer (AJCC) nodal status. The medical records of BR/LAPC patients who underwent surgery with curative intent were retrospectively reviewed. The nodal status was compared between patients who underwent upfront surgery (UFS) and those who received NAT. Moreover, clinicopathological factors and prognostic factors for overa...
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Complete surgical resection is the cornerstone of curative therapy for resectable pancreatic adenocarcinoma. Upfront surgery is the gold standard, but it is rarely curative. Neoadjuvant treatment is a logical option, as it may overcome some of the limitations of adjuvant therapy and has already shown some encouraging results. The main concern regarding neoadjuvant therapy is the risk of disease progression during chemotherapy, meaning the opportunity to undergo the intended curative surgery is m...
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Sep 1, 2021·Pancreas3.33
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#2Natasha LeighH-Index: 6
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OBJECTIVES Currently, there is no guidance for optimal adjuvant chemotherapy selection after pancreatectomy with a partial or poor response to neoadjuvant therapy. This study seeks to describe an institution's practice patterns of adjuvant chemotherapy selection after neoadjuvant therapy. METHODS Patients at a single institution receiving neoadjuvant chemotherapy followed by pancreatectomy for pancreatic cancer were reviewed. Patients enrolled in trials or without follow-up were excluded. Types ...
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Aug 24, 2021·Pancreatology4.00
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#2Shugo Mizuno (Mie University)H-Index: 25
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Abstract null null Background null The clinical value and predictors of a favorable histological response to preoperative chemoradiotherapy (CRT) in pancreatic ductal adenocarcinoma (PDAC) remains undefined. null null null Objective null To assess the significance and predictors of a favorable histological response to preoperative CRT in patients with localized PDAC. null null null Methods null The study included 203 patients with localized PDAC undergoing curative-intent resection after CRT. Th...
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Abstract null null Background null Most patients with pancreatic adenocarcinoma (PDAC) do not undergo surgical resection. The role of radiotherapy (RT) in non-operatively managed localized pancreatic adenocarcinoma is unclear. null null null Methods null The National Cancer Database (2010–2016) was queried for patients with clinical stage II-III PDAC treated with multiagent systemic chemotherapy (CT) +/− RT but not surgery. Factors associated with the receipt of RT and overall survival were comp...
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Aug 6, 2021·Chinese clinical oncology
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Background null Pancreatic cancer represents a systemic disease, and its treatment ideally includes the administration of systemic therapy regardless of its anatomical stage. null Methods null In this brief narrative review, the most recent literature will be highlighted, together with updates, new perspectives on the topic, and the authors own personal view. null Results null While preoperative therapy has recently become the new standard for borderline resectable stages, adjuvant therapy after...
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Jul 21, 2021·World Journal of Gastroenterology5.74
#1Ahmad Hamad (The Ohio State University Wexner Medical Center)H-Index: 5
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that is best treated in a multidisciplinary fashion using surgery, chemotherapy, and radiation. Adjuvant chemotherapy has shown to have a significant survival benefit in patients with resected PDAC. However, up to 50% of patients fail to receive adjuvant chemotherapy due to postoperative complications, poor patient performance status or early disease progression. In order to ensure the delivery of chemotherapy, an alternative st...
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Abstract Background The aim of this study was to investigate outcomes associated with neoadjuvant chemotherapy in patients undergoing pancreatoduodenectomy for early stage pancreatic adenocarcinoma in the era of modern chemotherapy. Methods The National Cancer Database (2010–2016) was queried for patients with clinical stage 0–2 pancreatic adenocarcinoma who underwent pancreatoduodenectomy. Patients who underwent up-front pancreatoduodenectomy were propensity matched to patients who received neo...
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Pancreatic ductal adenocarcinoma (PDAC) remains deadly despite advances in systemic therapies and surgical techniques. While there is increasing utilization of immune therapies across diverse cancer types, PDAC remains generally resistant to these treatments. We report a case of locally advanced PDAC treated with preoperative radiation and anti-PD-1 immunotherapy guided by preoperative PD-L1 tumor analysis. After 4 months of preoperative therapy, the patient was submitted to resection, demonstra...
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May 21, 2021·Annals of Surgical Oncology5.34
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