The neoadjuvant approach in resectable pancreatic ductal adenocarcinoma: lessons learned
Mené sur 77 patient atteints d'un adénocarcinome canalaire pancréatique résécable, cet essai multicentrique de phase II évalue l'efficacité, du point de vue de la survie globale à 18 mois, et la toxicité d'une chimiothérapie néoadjuvante de type FOLFIRINOX
Neoadjuvant chemotherapy in resectable pancreatic ductal adenocarcinoma is not currently recommended as standard practice but can be considered for patients at high risk (eg, high CA19-9, systemic symptoms, or nodal disease) or in a clinical trial. The PRODIGE24/CCTG-PA.6 adjuvant trial demonstrated the longest median overall survival reported to date of 53·5 months (95% CI 43·5–58·4) in a select cohort and documented the importance of completing adjuvant therapy. 3 In the real-world setting, up to half of patients do not receive postoperative chemotherapy, and thus a neoadjuvant approach might allow for improved delivery of chemotherapy. 4 In addition, up to 25% of patients might have metastatic disease on early postoperative imaging. 5 A test of biology allows for selection of those most likely to benefit from surgery. However, we still do not have evidence from randomised controlled trials to support the use of neoadjuvant chemotherapy in resectable pancreatic ductal adenocarcinoma (table). In this regard, Knut Jørgen Labori and colleagues are to be congratulated on conducting the exploratory multicentre, randomised, phase 2 NORPACT-1 trial evaluating the role of neoadjuvant fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) followed by surgery versus surgery and adjuvant chemotherapy (physicians' choice), the results of which are reported in The Lancet Gastroenterology & Hepatology.