Efficacy of neoadjuvant chemotherapy for locally advanced pancreatic cancer: a single institution retrospective review

Abstract

Introduction: Pancreatic cancer has extremely dismal prognosis and resection is the only modality to achieve prolonged survival rates. There is a strong rationale of neoadjuvant chemotherapy in locally advanced pancreatic cancer (LAPC). Objective of this study is to see the effect of neoadjuvant chemotherapy on tumor response, resection and survival rates in LAPC. Methods: Patients with locally advanced pancreatic adenocarcinoma managed at Shaukat Khanum Cancer hospital, Lahore, Pakistan from 2011 to 2015 were included. Data recorded on age, Eastern Cooperative Oncology Group(ECOG)score, pre-treatment CA-19.9 levels, type and number of chemotherapy cycles, response rates(RR) and overall survival (OS). OS by Kaplan Meier method was the interval between the date of diagnosis and last visit/death Results: Thirty four patients with LAPC with a median age of 62 years were included. The ECOG score was 0 in 64% and 1 in 36% of patients respectively. Pre-treatment CA-19.9 ranged from 19.5 to 32469 units/ml. FOLFIRINOX was the only regimen used as chemotherapy with median number of 6 chemotherapy cycles. Twenty one patients completed all chemotherapy cycles. The response rate (RR) was 29% as 4 (19%) patients had partial response (PR) and 2(10%) patients had complete response (CR). These 2(10%) patients with complete response became resectable and later on underwent resection and one patient achieved near pathological complete response. Nine out of 21 patients were alive at a median follow up of 16 months. Median survival by Kaplan Meier method was yet not reached. Conclusion: Considering worst prognosis of pancreatic cancer with possibility of resection being the only option for prolonged survival, these patients with locally advanced pancreatic cancer should be included in neoadjuvant treatment chemo protocols with subsequent re-evaluation for possibility of resection.