Neoadjuvant FOLFIRINOX for Patients with Borderline Resectable or Locally Advanced Pancreatic Cancer: Results of a Decision Analysis

Conclusion.Our modeling analysis suggests that nFOLFIRINOX is preferable to upfront surgery for patients with BR/LA PDAC from both an effectiveness and cost‐effectiveness standpoint. Additional clinical data that further define the long‐term effectiveness of nFOLFIRINOX are needed to confirm our results.Implications for Practice.Increasingly, neoadjuvant FOLFIRINOX has been used for borderline resectable and locally advanced pancreatic cancer with the goal of rendering them resectable and decreasing risk of recurrence. Despite many efforts to show the benefits of neoadjuvant over adjuvant therapies, clinical evidence to guide this decision is largely lacking. Decision‐analytic modeling can provide a methodologic platform that integrates the best available data to quantitatively explore clinical decisions by simulating a hypothetical clinical trial. This modeling analysis suggests that neoadjuvant FOLFIRINOX is preferable to upfront surgery and adjuvant therapies by various outcome metrics including quality‐adjusted life years, overall survival, and incremental cost‐effectiveness ratio.
Source: The Oncologist - Category: Cancer & Oncology Authors: Tags: Health Outcomes and Economics of Cancer Care, Gastrointestinal Cancer Source Type: research

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AbstractThe application of robotic technology allows for the performance of multi-organ liver resections by multidisciplinary teams in a minimally invasive manner. Their technique and outcomes are not established. Herein we describe our technique with robotic liver surgery combined with colon, pancreas and urologic resections. Our patients are an 84-year-old (yo) female (Body Mass Index, BMI: 25) with a recently diagnosed right colon adenocarcinoma and two synchronous liver metastases at segments 5 and 6, a 75-year-old female (BMI: 50.4) with a history of right renal cell cancer status post (s/p) right robotic radical neph...
Source: Journal of Robotic Surgery - Category: Surgery Source Type: research
Publication date: Available online 30 August 2019Source: Seminars in Ultrasound, CT and MRIAuthor(s): Axel Dallongeville, Lucie Corno, Stéphane Silvera, Isabelle Boulay-Coletta, Marc ZinsAbstractComputed Tomography remains the optimal imaging modality for both diagnosis and staging of pancreatic adenocarcinoma. Especially, CT is highly accurate in assessing the relationship of the tumor to critical arterial and venous structures, since their involvement can preclude surgical resection or indicate a neoadjuvant strategy in borderline resectable or locally advanced lesions. MRI provides additional staging information ...
Source: Seminars in Ultrasound, CT and MRI - Category: Radiology Source Type: research
We aimed to evaluate the efficacy and safety of 5-fluorouracil-based neoadjuvant chemoradiotherapy (NACRT) in patients with resectable/borderline resectable pancreatic ductal adenocarcinoma (PDAC).
Source: World Journal of Surgical Oncology - Category: Cancer & Oncology Authors: Tags: Research Source Type: research
AbstractBackgroundStudies have demonstrated that multimodality therapy and surgery at high volume centers are associated with a longer survival. However, it is unknown if these data have translated into national changes in care delivery.MethodsPatients with stages I –III pancreatic adenocarcinomas who underwent resections between 2004 and 2010 were identified from the National Cancer Data Base. The primary outcome was a 3-year overall survival. Temporal trends in survival outcomes and treatment variables were measured. A mediation analysis using the Lin metho d was used to discern the relative contribution of changes...
Source: Journal of Gastrointestinal Surgery - Category: Surgery Source Type: research
Objective: To compare the survival outcomes associated with clinical and pathological response in pancreatic ductal adenocarcinoma (PDAC) patients receiving neoadjuvant chemotherapy (NAC) with FOLFIRINOX (FLX) or gemcitabine/nab-paclitaxel (GNP) followed by curative-intent pancreatectomy. Background: Newer multiagent NAC regimens have resulted in improved clinical and pathological responses in PDAC; however, the effects of these responses on survival outcomes remain unknown. Methods: Clinicopathological and survival data of PDAC patients treated at 7 academic medical centers were analyzed. Primary outcomes were ove...
Source: Annals of Surgery - Category: Surgery Tags: PAPERS OF THE 139TH ASA ANNUAL MEETING Source Type: research
The American Society of Clinical Oncology guidelines recommend adjuvant chemoradiation for margin ‐positive (R1) and/or node‐positive (N+) pancreatic cancers. However, it is unclear if addition of adjuvant radiation to chemotherapy improves overall survival in this high‐risk cohort. In this propensity‐matched analysis of high‐risk pancreatic cancer patients (R1 or N+) from a large clin ical oncology database, we evaluate the benefit of adding adjuvant radiation to chemotherapy. We found evidence of superiority of adjuvant chemoradiation over adjuvant radiation alone in N+ patients but not in R1N0 patients. Abstra...
Source: Cancer Medicine - Category: Cancer & Oncology Authors: Tags: ORIGINAL RESEARCH Source Type: research
Although pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy, incremental progress has been realized over the past decade with new chemotherapeutic regimens, advanced surgical techniques, and an improved understanding of genetics. Although most patients are not candidates for surgical resection because of metastatic disease, many centers are focused on offering curative treatment for patients with borderline resectable (BR) or locally advanced (LA) tumors. These patients are treated with chemotherapy and radiation up front followed by surgical resection, and surgery often includes the resection and reconstr...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research
simo Sperti Despite improvements to surgical procedures and novel combinations of drugs for adjuvant and neoadjuvant therapies for pancreatic adenocarcinoma, the recurrence rate after radical surgery is still high. Little is known about the role of surgery in the treatment of isolated recurrences of pancreatic cancer. The aim of this study was to review the current literature dealing with surgery for recurrent pancreatic cancer in order to examine its feasibility and effectiveness. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIS...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Review Source Type: research
CONCLUSIONS: Current evidence suggests that neoadjuvant chemotherapy has a beneficial effect on overall survival in resectable pancreatic ductal adenocarcinoma in comparison with upfront surgery and adjuvant therapy. Further trials are needed to address the need for practice change. PMID: 31304767 [PubMed - as supplied by publisher]
Source: Annals of the Royal College of Surgeons of England - Category: Surgery Authors: Tags: Ann R Coll Surg Engl Source Type: research
Several new treatment options have become available for pancreatic ductal adenocarcinoma (PDAC), but the support for their use for resectable, borderline resectable and locally advanced PDAC is unclear.
Source: BMC Cancer - Category: Cancer & Oncology Authors: Tags: Research article Source Type: research
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