A single-arm, nonrandomized phase II trial of neoadjuvant gemcitabine and oxaliplatin in patients with resectable pancreas adenocarcinoma.

Published

Journal Article

BACKGROUND: The role for neoadjuvant systemic therapy in resectable pancreas adenocarcinoma remains undefined. OBJECTIVE: We evaluated the efficacy of gemcitabine and oxaliplatin administered as preoperative therapy in patients with resectable pancreas adenocarcinoma. METHODS: Eligible patients were screened using computed tomography-pancreas angiography, laparoscopy, endoscopic ultrasonography, and fine-needle aspiration cytology to identify 38 patients who received 4 cycles of neoadjuvant gemcitabine 1000 mg/m intravenously over 100 minutes and oxaliplatin 80 mg/m intravenously over 2 hours, every 2 weeks. Patients whose tumors remained resectable at restaging proceeded to operation and subsequently received 5 cycles of adjuvant gemcitabine (1000 mg/m intravenously over 30 minutes days 1, 8, and 15 every 4 weeks). The primary endpoint was 18-month overall survival and secondary endpoints included radiological, tumor marker and pathological response to neoadjuvant therapy, time to recurrence, patterns of failure, and feasibility of obtaining preoperative core biopsies. RESULTS: Thirty-five of 38 patients (92%) completed neoadjuvant therapy. Twenty-seven patients underwent tumor resection (resectability rate 71%), of which 26 initiated adjuvant therapy for a total of 23 patients (60.5%) who completed all planned therapy. The 18-month survival was 63% (24 patients alive). The median overall survival for all 38 patients was 27.2 months (95% confidence interval: 17-NA) and the median disease-specific survival was 30.6 months (95% confidence interval: 19-NA). CONCLUSIONS: This study met its endpoint and provided a signal suggesting that exploration of neoadjuvant systemic therapy is worthy of further investigation in resectable pancreas adenocarcinoma. Improved patient selection and more active systemic regimens are key. Clinical trials identification: NCT00536874.

Full Text

Duke Authors

Cited Authors

  • O╩╝Reilly, EM; Perelshteyn, A; Jarnagin, WR; Schattner, M; Gerdes, H; Capanu, M; Tang, LH; LaValle, J; Winston, C; DeMatteo, RP; D╩╝Angelica, M; Kurtz, RC; Abou-Alfa, GK; Klimstra, DS; Lowery, MA; Brennan, MF; Coit, DG; Reidy, DL; Kingham, TP; Allen, PJ

Published Date

  • July 2014

Published In

Volume / Issue

  • 260 / 1

Start / End Page

  • 142 - 148

PubMed ID

  • 24901360

Pubmed Central ID

  • 24901360

Electronic International Standard Serial Number (EISSN)

  • 1528-1140

Digital Object Identifier (DOI)

  • 10.1097/SLA.0000000000000251

Language

  • eng

Conference Location

  • United States