The Sequencing Conundrum in Localized Pancreatic Adenocarcinoma—Progress or Passive Acceptance?
Mené sur 46 patients atteints d'un cancer résécable du pancréas (âge médian : 65 ans), cet essai non randomisé de phase II évalue l'efficacité, du point de vue de la survie sans progression, d'un traitement péropératoire (néoadjuvant et adjuvant) de type FOLFIRINOX modifié
Despite years of surgical and therapeutic advances, pancreatic ductal adenocarcinoma (PDAC) remains a deadly disease with dismal long-term outcomes. Multimodality treatment with systemic chemotherapy in localized PDAC has shown incremental improvements in survival; however, many questions linger, with the most pressing being what is the correct sequencing in perioperative therapy? Neoadjuvant therapy is preferred in borderline resectable disease given improved R0 resection rates and overall survival (OS). However, in upfront resectable disease, there are conflicting schools of thought and varying institutional practices. Adjuvant chemotherapy with modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) has shown superiority over single-agent gemcitabine and is the recommended treatment per National Comprehensive Cancer Network guidelines after upfront pancreatectomy. However, given the aggressive nature of PDAC, upfront chemotherapy first could potentially eradicate micrometastases early and also help ascertain the biology of the cancer, sparing a futile surgical procedure if there is development of metastasis during initial systemic therapy.