Neoadjuvant therapy in borderline resectable and resectable pancreatic cancer.

Abstract

735 Background: To improve clinical outcomes in borderline resectable and resectable pancreatic cancer patients, preoperative chemotherapy with or without radiation can be administered. According to NCCN, there is limited evidence to recommend a specific neoadjuvant chemotherapy regimen. The Dutch randomized phase III PREOPANC trial showed that preoperative chemoradiotherapy led to improved disease free survival. We compared overall survival (OS) between two chemotherapy regimens; mFOLFIRINOX (mFOL) and Gemcitabine/nabPaclitaxel (Gem/nabP). Methods: We performed a retrospective analysis of biopsy-proven pancreatic cancer patients from 1/1/2019 to 2/1/2024. We included borderline resectable and resectable pancreatic cancer patients who received neoadjuvant chemotherapy and then underwent pancreatic resection. We divided them into two cohorts: those receiving mFOL and those receiving Gem/nabP. Kaplan-Meier and multivariate Cox regression analyses were performed to analyze OS and rates of R 0 resection amongst the two groups. A p-value < 0.05 was deemed statistically significant. Results: From January 2019 to January 2024, 85 pancreatic cancer patients received preoperative chemotherapy prior to pancreatic resection. 50 patients received mFOL and 35 patients received Gem/nabP. The mean overall survival (OS) for the mFOL group was 1,137 days, while for the Gem/nabP group it was 876 days. The hazard ratio was estimated as 1.692 (confidence interval 0.901- 3.177, p-value 0.10). After matching for pathological stage and grade, preoperative radiation, postoperative chemotherapy, and presence of perineural and lymphovascular invasion, the hazard ratio was 1.981 (p-value 0.065). The R 0 resection rate was 92.1% for mFOL and 82.2% for Gem/nabP. The odds ratio for having negative margins with mFOL compared to Gem/nabP was 2.005 with a p-value of 0.37. Conclusions: Preoperative chemotherapy with mFOL did not demonstrate improved OS compared to Gem/nabP. The probability of achieving negative margins was also similar amongst the two groups. The SWOG S1505 which is a randomized phase II trial comparing perioperative chemotherapy with mFOL versus Gem/nabP in resectable pancreatic cancer patients has also shown similar OS and progression free survival in both groups.