Neoadjuvant treatment of pancreatic adenocarcinoma

A systematic review and meta-analysis of 5520 patients

Mashaal Dhir, Gautam K. Malhotra, Davendra P.S. Sohal, Nicholas A. Hein, Lynette M Smith, Eileen M. O'Reilly, Nathan Bahary, Chandrakanth Are

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Recent years have seen standardization of the anatomic definitions of pancreatic adenocarcinoma, and increasing utilization of neoadjuvant therapy (NAT). The aim of the current review was to summarize the evidence for NAT in pancreatic adenocarcinoma since 2009, when consensus criteria for resectable (R), borderline resectable (BR), and locally advanced (LA) disease were endorsed. Methods: PubMed search was undertaken along with extensive backward search of the references of published articles to identify studies utilizing NAT for pancreatic adenocarcinoma. Abstracts from ASCO-GI 2014 and 2015 were also searched. Results: A total of 96 studies including 5520 patients were included in the final quantitative synthesis. Pooled estimates revealed 36% grade ≥ 3 toxicities, 5% biliary complications, 21% hospitalization rate and low mortality (0%, range 0-16%) during NAT. The majority of patients (59%) had stable disease. On an intention-to-treat basis, R0-resection rates varied from 63% among R patients to 23% among LA patients. R0 rates were > 80% among all patients who were resected after NAT. Among R and BR patients who underwent resection after NAT, median OS was 30 and 27.4 months, respectively. Conclusions: The current study summarizes the recent literature for NAT in pancreatic adenocarcinoma and demonstrates improving outcomes after NAT compared to those historically associated with a surgery-first approach for pancreatic adenocarcinoma.

Original languageEnglish (US)
Article number183
JournalWorld Journal of Surgical Oncology
Volume15
Issue number1
DOIs
StatePublished - Oct 10 2017

Fingerprint

Neoadjuvant Therapy
Meta-Analysis
Adenocarcinoma
PubMed
Consensus
Hospitalization
Mortality

Keywords

  • Neoadjuvant therapy
  • Outcomes
  • Pancreatic adenocarcinoma
  • Pancreatic cancer
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Neoadjuvant treatment of pancreatic adenocarcinoma : A systematic review and meta-analysis of 5520 patients. / Dhir, Mashaal; Malhotra, Gautam K.; Sohal, Davendra P.S.; Hein, Nicholas A.; Smith, Lynette M; O'Reilly, Eileen M.; Bahary, Nathan; Are, Chandrakanth.

In: World Journal of Surgical Oncology, Vol. 15, No. 1, 183, 10.10.2017.

Research output: Contribution to journalArticle

Dhir, Mashaal ; Malhotra, Gautam K. ; Sohal, Davendra P.S. ; Hein, Nicholas A. ; Smith, Lynette M ; O'Reilly, Eileen M. ; Bahary, Nathan ; Are, Chandrakanth. / Neoadjuvant treatment of pancreatic adenocarcinoma : A systematic review and meta-analysis of 5520 patients. In: World Journal of Surgical Oncology. 2017 ; Vol. 15, No. 1.
@article{7c5079a6dd89479fb6dc255c1d9d60d2,
title = "Neoadjuvant treatment of pancreatic adenocarcinoma: A systematic review and meta-analysis of 5520 patients",
abstract = "Background: Recent years have seen standardization of the anatomic definitions of pancreatic adenocarcinoma, and increasing utilization of neoadjuvant therapy (NAT). The aim of the current review was to summarize the evidence for NAT in pancreatic adenocarcinoma since 2009, when consensus criteria for resectable (R), borderline resectable (BR), and locally advanced (LA) disease were endorsed. Methods: PubMed search was undertaken along with extensive backward search of the references of published articles to identify studies utilizing NAT for pancreatic adenocarcinoma. Abstracts from ASCO-GI 2014 and 2015 were also searched. Results: A total of 96 studies including 5520 patients were included in the final quantitative synthesis. Pooled estimates revealed 36{\%} grade ≥ 3 toxicities, 5{\%} biliary complications, 21{\%} hospitalization rate and low mortality (0{\%}, range 0-16{\%}) during NAT. The majority of patients (59{\%}) had stable disease. On an intention-to-treat basis, R0-resection rates varied from 63{\%} among R patients to 23{\%} among LA patients. R0 rates were > 80{\%} among all patients who were resected after NAT. Among R and BR patients who underwent resection after NAT, median OS was 30 and 27.4 months, respectively. Conclusions: The current study summarizes the recent literature for NAT in pancreatic adenocarcinoma and demonstrates improving outcomes after NAT compared to those historically associated with a surgery-first approach for pancreatic adenocarcinoma.",
keywords = "Neoadjuvant therapy, Outcomes, Pancreatic adenocarcinoma, Pancreatic cancer, Survival",
author = "Mashaal Dhir and Malhotra, {Gautam K.} and Sohal, {Davendra P.S.} and Hein, {Nicholas A.} and Smith, {Lynette M} and O'Reilly, {Eileen M.} and Nathan Bahary and Chandrakanth Are",
year = "2017",
month = "10",
day = "10",
doi = "10.1186/s12957-017-1240-2",
language = "English (US)",
volume = "15",
journal = "World Journal of Surgical Oncology",
issn = "1477-7819",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Neoadjuvant treatment of pancreatic adenocarcinoma

T2 - A systematic review and meta-analysis of 5520 patients

AU - Dhir, Mashaal

AU - Malhotra, Gautam K.

AU - Sohal, Davendra P.S.

AU - Hein, Nicholas A.

AU - Smith, Lynette M

AU - O'Reilly, Eileen M.

AU - Bahary, Nathan

AU - Are, Chandrakanth

PY - 2017/10/10

Y1 - 2017/10/10

N2 - Background: Recent years have seen standardization of the anatomic definitions of pancreatic adenocarcinoma, and increasing utilization of neoadjuvant therapy (NAT). The aim of the current review was to summarize the evidence for NAT in pancreatic adenocarcinoma since 2009, when consensus criteria for resectable (R), borderline resectable (BR), and locally advanced (LA) disease were endorsed. Methods: PubMed search was undertaken along with extensive backward search of the references of published articles to identify studies utilizing NAT for pancreatic adenocarcinoma. Abstracts from ASCO-GI 2014 and 2015 were also searched. Results: A total of 96 studies including 5520 patients were included in the final quantitative synthesis. Pooled estimates revealed 36% grade ≥ 3 toxicities, 5% biliary complications, 21% hospitalization rate and low mortality (0%, range 0-16%) during NAT. The majority of patients (59%) had stable disease. On an intention-to-treat basis, R0-resection rates varied from 63% among R patients to 23% among LA patients. R0 rates were > 80% among all patients who were resected after NAT. Among R and BR patients who underwent resection after NAT, median OS was 30 and 27.4 months, respectively. Conclusions: The current study summarizes the recent literature for NAT in pancreatic adenocarcinoma and demonstrates improving outcomes after NAT compared to those historically associated with a surgery-first approach for pancreatic adenocarcinoma.

AB - Background: Recent years have seen standardization of the anatomic definitions of pancreatic adenocarcinoma, and increasing utilization of neoadjuvant therapy (NAT). The aim of the current review was to summarize the evidence for NAT in pancreatic adenocarcinoma since 2009, when consensus criteria for resectable (R), borderline resectable (BR), and locally advanced (LA) disease were endorsed. Methods: PubMed search was undertaken along with extensive backward search of the references of published articles to identify studies utilizing NAT for pancreatic adenocarcinoma. Abstracts from ASCO-GI 2014 and 2015 were also searched. Results: A total of 96 studies including 5520 patients were included in the final quantitative synthesis. Pooled estimates revealed 36% grade ≥ 3 toxicities, 5% biliary complications, 21% hospitalization rate and low mortality (0%, range 0-16%) during NAT. The majority of patients (59%) had stable disease. On an intention-to-treat basis, R0-resection rates varied from 63% among R patients to 23% among LA patients. R0 rates were > 80% among all patients who were resected after NAT. Among R and BR patients who underwent resection after NAT, median OS was 30 and 27.4 months, respectively. Conclusions: The current study summarizes the recent literature for NAT in pancreatic adenocarcinoma and demonstrates improving outcomes after NAT compared to those historically associated with a surgery-first approach for pancreatic adenocarcinoma.

KW - Neoadjuvant therapy

KW - Outcomes

KW - Pancreatic adenocarcinoma

KW - Pancreatic cancer

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=85030866892&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030866892&partnerID=8YFLogxK

U2 - 10.1186/s12957-017-1240-2

DO - 10.1186/s12957-017-1240-2

M3 - Article

VL - 15

JO - World Journal of Surgical Oncology

JF - World Journal of Surgical Oncology

SN - 1477-7819

IS - 1

M1 - 183

ER -