The move away from surgical diagnosis to radiographic criteria in many and now even most efforts at the staging of pancreatic cancer (ductal adenocarcinoma of the pancreas) carries a number of somewhat unspoken but profound consequences, one being efforts to find ways to downstage the diagnosis so as to profitably utilize surgery in locally advanced and borderline resectable pancreatic cancer. We have thus seen the rise of the use of chemotherapy alone or in combination with other modalities in induction neoadjuvant treatment in order to accomplish this.
But this is somewhat new territory. For example, it is not clear what the optimal duration of such neoadjuvant therapy should be. Thus, it comes with great interest that Donahue, Reber and colleagues at UCLA have reviewed their experience in this realm over the past two decades – with a rather startling finding: that prolonged duration of neoadjuvant therapy appears to confer a large benefit in many cases. This work has been published in the February 2014 issue of the journal JAMA Surgery (formerly Archives of Surgery).
The UCLA researchers reviewed patients treated at their institution from 1992 until 2011, identifying 49 patients who were Stage III / locally advanced or who were considered borderline resectable, AND who completed preoperative treatment – with a median duration of 7.1 months. A remarkable 75.5% of these patients were able to later undergo surgery. Most of these patients were lymph node negative at the time of surgery. The median overall survival duration of this studied group was 40.1 months.
Prolonged pre-surgical therapy appears to offer large benefit to select patients. This finding requires further study, but is highly encouraging.
Dale O’Brien, MD