Pancreatic cancer is a devastating disease with limited treatment options and poor survival rates. It is particularly challenging when the cancer is borderline resectable, meaning that the tumor is technically able to be removed surgically, but with a high risk of the cancer returning due to positive margins. In a recent pilot study presented at the annual meeting of the American Association for Cancer Research (AACR), Dr. Zev Wainberg reported promising results from a combination of chemotherapy and immunotherapy as a neoadjuvant treatment for borderline resectable pancreatic cancer.
The phase I/II trial involved 28 patients who received a combination of modified FOLFIRINOX chemotherapy and the PD-1 checkpoint inhibitor nivolumab for 3 to 6 months. If the patients responded well after 3 months of treatment, they were eligible for surgical resection. The study showed favorable outcomes, with 21 out of 28 patients achieving R0 resections and a median progression-free survival of 21.9 months. Patients who underwent surgery had a median overall survival of 34.6 months, with a high resection rate of 79%.
The success of achieving an R0 resection, where no cancer cells are found at the margins of the removed tumor, is crucial for improving survival outcomes in pancreatic cancer. Dr. Wainberg emphasized the importance of introducing chemotherapy and immunotherapy in the neoadjuvant setting to increase the likelihood of achieving R0 resections in borderline resectable pancreatic cancer patients.
Compared to historical controls, the combination of modified FOLFIRINOX and nivolumab showed higher 12- and 18-month overall survival rates of 82% and 77%, respectively. These results surpass the outcomes seen in previous studies using chemotherapy alone for borderline resectable pancreatic cancer. The study also demonstrated a low rate of adverse events and postoperative complications, highlighting the safety and tolerability of the treatment regimen.
The success of this pilot study suggests that a combination of chemotherapy and immunotherapy in the neoadjuvant setting could be a promising approach for treating borderline resectable pancreatic cancer. Dr. Wainberg and his team advocate for further studies to explore the impact of these drugs on tumor biology in less-advanced disease stages. Moving forward, research efforts should focus on optimizing the timing and combination of therapies to improve outcomes for pancreatic cancer patients.
The utilization of preoperative chemotherapy and immunotherapy in borderline resectable pancreatic cancer patients shows great promise in improving the rates of R0 resection and overall survival. The results of this pilot study provide a strong foundation for future research in neoadjuvant treatment strategies for pancreatic cancer. By continuing to explore innovative approaches to combat this aggressive disease, we may ultimately improve outcomes and quality of life for patients facing pancreatic cancer.
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