What is the proportion of patients that go on to surgery after nt in pdac

1. What proportion of
patients that receive
NT go on to resection
in resectable PDAC?
Yana Puckett, MD, MBA, MPH, MSc
Complex General Surgical Oncology Fellow

2. Benefit of Neoadjuvant Treatment in
PDAC
• Treat micro-metastatic disease
• Increase rate of chemotherapy delivery
• Prevent futile surgery in aggressive disease
• Delivery of treatment to well-oxygenated tissue
(enhanced efficacy of chemo/xrt)

3. Meta-Analysis
• 1966 to 2015
• 18 studies analyzed for borderline resectable pancreatic cancer
• Complete response 2.8%
• Partial response 28.7%
• Stable disease 45.9%
• Progression 16.9%
• Resection in 65.3%
• Median survival was 25.9 months for resected patients, 11.9
months for unresected patients¹
¹Tang, Kezhong, et al. "Neoadjuvant therapy for patients with borderline resectable pancreatic cancer: a systematic review and meta-analysis of
response and resection percentages." Pancreatology 16.1 (2016): 28-37.

4. Use of NT in United States
• Retrospective study published May 2020
• 58,124 patients
• NCDB database 2004-2016
• ~25% of resectable PDAC pts receive NT in US¹
• Use of NT increased from 3.5% in 2004 to 26.4% in
2016.¹
¹Cloyd, J. M., Shen, C., Santry, H., Bridges, J., Dillhoff, M., Ejaz, A., ... & Tsung, A. (2020). Disparities in the use of neoadjuvant therapy
for resectable pancreatic ductal adenocarcinoma. Journal of the National Comprehensive Cancer Network, 18(5), 556-563.

6. First Neoadjuvant Phase II Trial
• mid 1990s
• Fox Chase Cancer Center
• 5-FU/mitomycin c - radiotherapy
• N=26
• 10/26 (39%) were deemed unresectable at laparotomy.
• 10/26 were resected (39%)

7. MD Anderson
• n=39
• NT 5-FU based chemoradiation
• 33/39 (85%) underwent resection
• Used CT to define resectability
• Median survival was 19 months for resected patients

8. PERP-02/JASP-05
• Phase II/III trial neoadjuvant chemotherapy in resectable
pancreatic cancer
• Arm 1: NAC- Gemcitabine and S1 (tegafur/gimeracil/oteracil)
• Arm 2: Upfront surgery
• S1 adjuvant for curative resection patients x 6 months after
full recovery within 10 weeks after surgery in both arms.
• n=364
• 2013-2016
• Resection Rate was 81.4% in NAC arm
• Median OS 36.7 month is in NAC-GS and 26.6 mo in UP-S

10. Survival Results
Median OS 22.4 months vs 23.6
months

12. In Summary
• Patients not reaching surgery after NT ranges between 20-30%
based on available NT trials.
• Half due to progression of disease while on chemotherapy.
• Other half due to chemotherapy related toxicity.