Adjuvant Chemotherapy Is Not Guided by Pathologic Treatment Effect After Neoadjuvant Chemotherapy in Pancreatic Cancer. Issue 8 (September 2021)

• Record Type: Journal Article
• Authors: Gleeson, Elizabeth M.; Leigh, Natasha; Golas, Benjamin J.; Magge, Deepa; Sarpel, Umut; Hiotis, Spiros P.; Labow, Daniel M.; Pintova, Sofya; Cohen, Noah A.
• Is Part Of: Pancreas. Volume 50:Issue 8(2021)
• Page Start: 1163
• Page End: 1168
• Publication Date: 2021-09
• Subjects: CAP score -- FOLFIRINOX -- pancreatectomy -- pancreatic ductal adenocarcinoma -- BRCA - breast cancer gene -- CA 19-9 - carbohydrate antigen 19-9 -- CAP - College of American Pathologists -- CAPIRINOX - capecitabine, irinotecan, oxaliplatin -- CEA - carcinoembryonic antigen -- DNA - deoxyribonucleic acid -- ERCC1 - excision repair cross-complementing 1 -- FOLFIRINOX - 5-fluouracil, irinotecan, oxaliplatin -- NCCN - National Comprehensive Cancer Network -- NTRK - neurotrophic receptor tyrosine kinase 1 -- pCR - pathologic complete response -- RRM1 - ribonucleotide reductase catalytic subunit M1 -- TS - thymidylate synthase; Pancreas -- Diseases -- Periodicals; Pancreas -- Periodicals; Neuroendocrine tumors -- Periodicals; 616.37005
• DOI: 10.1097/MPA.0000000000001881
• Languages: English
• ISSNs: 0885-3177

Abstract

Abstract : 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 of chemotherapy, the College of American Pathologists pathologic tumor response, and medical oncology plans were recorded. Results: Forty-one patients met inclusion criteria. Pathologic review of treatment effect demonstrated that 3 patients (7.3%) had complete pathologic response, 3 (7.3%) had near complete pathologic response, 16 (39%) had partial response, and 14 (34.1%) had poor/no response to neoadjuvant chemotherapy. Fourteen of the 30 patients with partial or poor response (46.7%) received an alternate adjuvant regimen. Pathologic response to neoadjuvant chemotherapy specifically guided therapy in 11 (30.5%) patients. Conclusions: Despite 73.1% of patients with partial or poor response to neoadjuvant chemotherapy, only 46.7% received a different adjuvant regimen. Medical oncologists infrequently considered treatment effect when choosing adjuvant therapy. Pathologic response to neoadjuvant chemotherapy should be considered when selecting adjuvant chemotherapy.