A single-arm, phase II trial of neoadjuvant gemcitabine and S1 in patients with resectable and borderline resectable pancreatic adenocarcinoma: PREP-01 study
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Neoadjuvant chemotherapy (NAC) represents a promising alternative to pancreatic ductal adenocarcinoma (PDAC) planned resection, but the survival impact remains undefined. To assess the feasibility and survival outcomes of NAC with gemcitabine and S1 (GS) for PDAC planned resection by prospective study.
Patients with resectable or borderline resectable PDAC received 2 cycles of NAC-GS and were offered curative resection followed by gemcitabine adjuvant. The primary endpoint was 2-year overall survival (OS). Adverse events during NAC, radiological and tumor marker responses, resection rate, and surgical safety were evaluated as secondary endpoints (UMIN000004148).
We enrolled 104 patients between 2010 and 2012, with 101 patients treated using NAC-GS as the full analysis set (FAS). Of the 101 patients, 88% received the planned 2 cycles of NAC. Grade 3 neutropenia was common (35%). Radiological partial response and decreased carbohydrate antigen 19-9 concentration (> 50% decrease) were noted in 13% and 41%, respectively. R0/1 resections with M0 were performed in 65 patients without surgical mortality. Of the 65 patients, 44 received planned gemcitabine adjuvant for 6 months as the on-protocol cohort. The primary endpoint for the 2-year OS rate was 55.9% in the FAS (n = 101) and 74.6% in the on-protocol cohort (n = 44).
NAC-GS was feasible and actively prolonged survival following PDAC planned resection. Randomized control trials are needed to further clarify the survival benefit of NAC-GS in addition to surgery followed by adjuvant therapy.
KeywordsNeoadjuvant Chemotherapy Pancreatic cancer Surgery
This work was supported in part by Grants-in-Aid for Scientific Research 24592018 from the Japan Society for the Promotion of Science. We would like to express sincere appreciation to Drs. M. Kurata, H. Yanagimoto, H. Toyama, Y. Nagakawa, K. Maemura, Y. Mataki, T. Akahori, S. Kinoshita, H. Terashima, A. Horiguchi, Y. Ohtsuka, A. Nanashima, K. Kanemitsu, H. Ohigashi, M. Tani, T. Takahara, H. Shiomi, I. Endo, H. Suzuki, T. Rikiyama, H. Ikoma, M. Yasunaga, K. Nakamura, S. Egawa, Y. Katayose, K. Nakagawa, K. Okada, and S. Ottomo as clinical investigators in the study group of preoperative therapy for pancreatic cancer (PREP).
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Conflict of interest
The authors declare no conflicts of interest.
- 7.Neoptolemos JP, Moore MJ, Cox TF, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012;308:147–56.CrossRefGoogle Scholar
- 19.NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Pancreatic Adenocarcinoma Version 3. 2017. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed 19 Oct 2017.
- 26.Motoi F, Unno M, Takahashi H, et al. Influenceof preoperative anti-cancer therapy on resectability and perioperative outcomes in patients with pancreatic cancer: project study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2014;21:148–58.CrossRefGoogle Scholar