Best of Best Poster Oral Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Use and Outcomes from Neoadjuvant chemotherapy in Borderline Resectable Pancreatic Ductal Adenocarcinoma in an Australasian Population (#327)

Belinda Lee 1 2 3 4 , Imogen Walpole 3 , Julia Shapiro 5 6 , Benjamin Thomson 4 7 8 , Lara Lipton 4 5 8 9 , Sumitra Ananda 4 9 10 , Val Usatoff 5 9 , Sue-Anne Mclachlan 11 , Brett Knowles 4 10 11 , Adrian Fox 11 12 , Rachel Wong 6 13 14 , Prasad Cooray 15 , Matthew Burge 16 , Kate Clarke 17 , Sharon Pattison 18 19 , Mehrdad Nikfarjam 20 21 , Niall Tebbutt 20 , Marion Harris 22 , Adnan Nagrial 23 , Rob Zielinski 24 25 26 , Cheng Ean Chee 27 , Peter Gibbs 1 2 9
  1. Walter and Eliza Hall Institute, Melbourne, VIC, Australia
  2. Faculty of Medicine & Health Sciences, University of Melbourne, Melbourne, VIC, Australia
  3. Northern Health, Epping, VIC, Australia
  4. Peter MacCallum Cancer Centre, Parkville, VIC, Australia
  5. Cabrini Hospital, Malvern, VIC, Australia
  6. Faculty of Medicine & Health Sciences, Monash University, Melbourne, Australia
  7. Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
  8. The Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia
  9. Western Health, Melbourne, VIC, Australia
  10. Melbourne Health, Melbourne, VIC, Australia
  11. St Vincents Hospital, Melbourne, VIC, Australia
  12. Eastern Health, Boxhill, Melbourne, Victoria, Australia
  13. Eastern Health, Boxhill, VIC, Australia
  14. Epworth Hospital, Boxhill, VIC, Australia
  15. Knox Private Hospital, Knox, VIC, Australia
  16. Royal Brisbane Hospital, Brisbane, QLD, Australia
  17. Wellington Hospital, Capital & Coast District Health, Wellington, New Zealand
  18. Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  19. Dunedin Hospital, Southern District Health, Dunedin, New Zealand
  20. Austin Health, Melbourne, Victoria, Australia
  21. Warringal Private Hospital, Heidelberg, VIC, Australia
  22. Monash Cancer Centre, Melbourne, VIC, Australia
  23. Crown Princess Mary Centre, Westmead, NSW, Australia
  24. Orange Hospital, Orange, NSW, Australia
  25. Dubbo Base Hospital, Dubbo, NSW, Australia
  26. Bathurst Base Hospital, Bathurst, NSW, Australia
  27. National University Cancer Institute, Singapore

Background:  International consensus guidelines recommend the use of neoadjuvant (NA) chemotherapy when pancreatic ductal adenocarcinoma (PDAC) is considered borderline resectable. The Australian practice has not been well described.

 

Methods: A retrospective analysis of consecutive patients with localized PDAC between January 2016 till March 2019 entered into the Australasian Pancreatic Cancer Registry (PURPLE: Pancreatic cancer: Understanding Routine Practice and Lifting end results) was performed. Clinicopathological characteristics, treatment administered, and outcome were analysed. Overall survival (OS) and relapse free survival (RFS) was compared using Log-rank and Kaplan-Meier analysis.

 

Results: At initial presentation, 754 cases had localized PDAC, of which 350 (47%) were resectable, 148 (20%) borderline and 247 (33%) unresectable. The majority of resectable cases (92%) underwent immediate surgery, 14 cases declined surgery and 13 are pending review. Of 148 borderline cases, 58 (39%) underwent immediate surgery, 79 (53%) received neoadjuvant chemotherapy and 11(7%) opted for best supportive care. The most frequently used NA chemotherapy was FOLFIRINOX (47/79, 54% patients) versus Gemcitabine/Nab-paclitaxel (30/79, 30% patients). Surgery was performed in 35% (28/79) of borderline resectable patients receiving NA chemotherapy, with 43% (12/28) R0 resections compared to 21% (12/58) in the upfront resected borderline cases. Patients receiving NA FOLFIRINOX were younger (59 versus 70 years) and NA FOLFIRINOX led to more resections (20/47, 43% vs 8/32, 25%) compared to NA Gemcitabine/Nab-paclitaxel. Median OS for early stage immediate resection versus borderline resectable cases receiving NA chemotherapy was 29.2 versus 21.7 (HR 0.57, p=0.005) months; and median RFS was 16.4 versus 10.8 months (HR 0.60, p=0.004).

 

Conclusions: The use of neoadjuvant chemotherapy in resectable pancreatic cancer remains infrequent in Australasia. Only a third of patients receiving neoadjuvant chemotherapy proceed to curative resection, with 43% achieving R0 resections. Newer treatment strategies and high-quality evidence are needed. These are being explored in the MASTERPLAN and DYNAMIC-Pancreas clinical trials.