Conversion Therapy for Locally Advanced Pancreatic Cancer: A Case Series and Literature Review

² Department of Medical Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P. R. China

³ Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P. R. China

⁴ The Qingdao University Medical College, Qingdao, Shandong 260075, P. R. China

†These authors contributed equally to this work.

CP 2020, 2(4), 25–31; https://doi.org/10.18063/cp.v2i4.298

Received: 24 August 2020 | Accepted: 26 October 2020 | Published online: 8 November 2020

© 2020 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )

Download PDF

Cite

XML

Abstract

Patients with locally advanced pancreatic cancer account for a large proportion of patients with pancreatic cancer. According to the National Comprehensive Cancer Network guidelines, the patients with good performance status can undergo chemotherapy or chemoradiotherapy. However, a growing number of clinical studies suggested that aggressive surgical treatment after chemotherapy may lead to longer survival. In this case series, we report the effect of conversion therapy in four patients with locally advanced pancreatic cancer who visited Zhejiang Provincial People’s Hospital from January 2015 to October 2020. The clinical evaluation and prognosis of these patients after conversion therapy were analyzed and discussed in conjunction with relevant literature. The median overall survival time of the patients was 21.5 months. One patient who underwent surgery after chemotherapy achieved R0 resection. Another patient gave up the opportunity of surgery in the process of conversion therapy, but has been living with the tumor since. Taken together, the patients with locally advanced pancreatic cancer can benefit from conversion therapy in achieving R0 resection or long-term survival if surgery is not implemented.

Keywords

Conversion therapy

Chemotherapy

Locally advanced unresectable pancreatic cancer

Surgery

References

Chen W, Zheng R, Baade PD, et al., 2016, Cancer Statistics in China, 2015. CA Cancer J Clin, 66:115–32.

Tempero MA, Malafa MP, Al-Hawary M, et al., 2017, Pancreatic Adenocarcinoma, Version 2. 2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 15:1028–61.

Strobel O, Büchler MW, 2016, Pancreatic Cancer: Clinical Practice Guidelines-What is the Evidence? Nat Rev Clin Oncol, 13:593–4. DOI: 10.1038/nrclinonc.2016.127.

Varadhachary GR, Tamm EP, Abbruzzese JL, et al., 2006, Borderline Resectable Pancreatic Cancer: Definitions, Management, and Role of Preoperative Therapy. Ann Surg Oncol, 13:1035–46. DOI: 10.1245/aso.2006.08.011.

Balaban EP, Mangu PB, Khorana AA, et al., 2016, Locally Advanced, Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol, 34:2654–68. DOI: 10.1200/jop.2016.017376.

Grossberg AJ, Chu LC, Deig CR, et al., 2020, Multidisciplinary Standards of Care and Recent Progress in Pancreatic Ductal Adenocarcinoma. CA Cancer J Clin, 70:375–403. DOI: 10.3322/caac.21626.

Hidalgo M, 2010, Pancreatic Cancer. N Engl J Med, 362:1605–17.

Lin H, Ma Y, Wang JZ, et al., 2016, Analysis of 300 Consecutive Cases of Pancreatic Adenocarcinoma in a Single-Center in China. Hepatobiliary Pancreat Dis Int, 15:189–97.

von Hoff DD, Ervin T, Arena FP, et al., 2013, Increased Survival in Pancreatic Cancer with Nab-Paclitaxel Plus Gemcitabine. N Engl J Med, 369:1691–703.

Conroy T, Desseigne F, Ychou M, et al., 2011, FOLFIRINOX Versus Gemcitabine for Metastatic Pancreatic Cancer. N Engl J Med, 364:1817–25.

Ueno H, Ioka T, Ikeda M, et al., 2013, Randomized Phase III Study of Gemcitabine Plus S-1, S-1 Alone, or Gemcitabine Alone in Patients with Locally Advanced and Metastatic Pancreatic Cancer in Japan and Taiwan: GEST Study. J Clin Oncol, 31:1640–8. DOI: 10.1200/jco.2012.43.3680.

Maggino L, Malleo G, Marchegiani G, et al., 2019, Outcomes of Primary Chemotherapy for Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma. JAMA Surg, 154:932–42. DOI: 10.1001/jamasurg.2019.2277.

Furuse J, Shibahara J, Sugiyama M, 2018, Development of Chemotherapy and Significance of Conversion Surgery after Chemotherapy in Unresectable Pancreatic Cancer. J Hepatobiliary Pancreat Sci, 25:261–8. DOI: 10.1002/jhbp.547.

Hank T, Strobel O, 2019, Conversion Surgery for Advanced Pancreatic Cancer. J Clin Med, 8:1945.

Yeo TP, Hruban RH, Leach SD, et al., 2020, Pancreatic Cancer. Curr Probl Cancer, 26:176–275.

Huguet F, Mukherjee S, Javle M, 2014. Locally Advanced Pancreatic Cancer: The Role of Definitive Chemoradiotherapy. Clin Oncol (R Coll Radiol), 26:560–8. DOI: 10.1016/j.clon.2014.06.002.

Suker M, Beumer BR, Sadot E, et al., 2016, FOLFIRINOX for Locally Advanced Pancreatic Cancer: A Systematic Review and Patient-Level Meta-Analysis. Lancet Oncol, 17:801–10. DOI: 10.1016/s1470-2045(16)00172-8.

Philip PA, Lacy J, Portales F, et al., 2020, Nab-Paclitaxel Plus Gemcitabine in Patients with Locally Advanced Pancreatic Cancer (LAPACT): A Multicentre, Open-Label Phase 2 Study. Lancet Gastroenterol Hepatol, 5:285–94. DOI: 10.1016/s2468-1253(19)30327-9.

Gillen S, Schuster T, Büschenfelde CM, et al., 2010, Preoperative/Neoadjuvant Therapy in Pancreatic Cancer: A Systematic Review and Meta-Analysis of Response and Resection Percentages. PLoS Med, 7:e1000267.

DOI: 10.1371/journal.pmed.1000267.

Strobel O, Berens V, Hinz U, et al., 2012, Resection after Neoadjuvant Therapy for Locally Advanced, “Unresectable” Pancreatic Cancer. Surgery, 152:S33–42. DOI: 10.1016/j.surg.2012.05.029.

Gemenetzis G, Groot VP, Blair AB, et al., 2019, Survival in Locally Advanced Pancreatic Cancer after Neoadjuvant Therapy and Surgical Resection. Ann Surg, 270:340–7. DOI: 10.1097/sla.0000000000002753.

Hackert T, Sachsenmaier M, Hinz U, et al., 2016, Locally Advanced Pancreatic Cancer: Neoadjuvant Therapy With Folfirinox Results in Resectability in 60% of the Patients. Ann Surg, 264:457–63. DOI: 10.1097/sla.0000000000001850.

Napolitano F, Formisano L, Giardino A, et al., 2019, Neoadjuvant Treatment in Locally Advanced Pancreatic Cancer (LAPC) Patients with FOLFIRINOX or Gemcitabine NabPaclitaxel: A Single-Center Experience and a Literature Review. Cancers (Basel), 11:981. DOI: 10.3390/cancers11070981.

Sun Y, Duan Q, Wang S, et al., 2015, Diagnosis of Pancreatic Cancer using 18F-FDG PET/CT and CA19-9 with SUVmax Association to Clinical Characteristics. J BUON, 20:452–9.

Smeenk HG, Tran TC, Erdmann J, et al., 2005, Survival after Surgical Management of Pancreatic Adenocarcinoma: Does Curative and Radical Surgery Truly Exist? Langenbecks Arch Surg, 390:94–103. DOI: 10.1007/s00423-004-0476-9.

Suenaga M, Fujii T, Kanda M, et al., 2014, Pattern of First Recurrent Lesions in Pancreatic Cancer: Hepatic Relapse is Associated with Dismal Prognosis and Portal Vein Invasion. Hepatogastroenterology, 61:1756–61.

Kleeff J, Reiser C, Hinz U, et al., 2007, Surgery for Recurrent Pancreatic Ductal Adenocarcinoma. Ann Surg, 245:566–72. DOI: 10.1097/01.sla.0000245845.06772.7d.

Ferrone CR, Marchegiani G, Hong TS, et al., 2015, Radiological and Surgical Implications of Neoadjuvant Treatment with FOLFIRINOX for Locally Advanced and Borderline Resectable Pancreatic Cancer. Ann Surg, 261:12–7. DOI: 10.3410/f.725318150.793554053.

Yoo C, Hwang I, Song TJ, et al., 2020, FOLFIRINOX in Borderline Resectable and Locally Advanced Unresectable Pancreatic Adenocarcinoma. Ther Adv Med Oncol, 12:1758835920953294. DOI: 10.1177/1758835920953294.

Gunturu KS, Yao X, Cong X, et al., 2013, FOLFIRINOX for Locally Advanced and Metastatic Pancreatic Cancer: Single Institution Retrospective Review of Efficacy and Toxicity. Med Oncol, 30:361. DOI: 10.1007/s12032-012-0361-2.

Chiorean EG, Cheung WY, Giordano G, et al., 2019, Real-World Comparative Effectiveness of Nab-Paclitaxel Plus Gemcitabine Versus FOLFIRINOX in Advanced Pancreatic Cancer: A Systematic Review. Ther Adv Med Oncol, 11:1758835919850367. DOI: 10.1177/1758835919850367.

Previous article in this issue

Next article in this issue

Cancer Plus, Electronic ISSN: 2661-3840 Print ISSN: 2661-3832, Published by AccScience Publishing