Neoadjuvant gemcitabine and nab-paclitaxel followed by concurrent capecitabine/radiation in borderline resectable (BR) pancreatic cancer: A single-institution experience.

Authors

null

Niraj K. Gupta

St. Vincent Cancer Care, Carmel, IN

Niraj K. Gupta , Kirpal Singh , Murad Aburajab , Vinay Mathavan , Mazen Al-Satie , Timothy Glass , Christopher A. Leagre , Michael Rowe , Thomas Tigges , Robert H. Liebross , Chad Davis , Sweta Tandra , Vas Tumati , Jianmin Tian , Brandon Martinez , Joshua Dowell , Kristen Kay Schmidt , Vincent Flanders

Organizations

St. Vincent Cancer Care, Carmel, IN, St. Vincent Hospital, Indianapolis, IN, St Vincent Cancer Care, Indianapolis, IN, St Vincent Cancer care, Indianapolis, IN, St Vincent Cancer Care, Carmel, IN, Cancer Care Grp, Carmel, IN, St Vincent Care, Indianapolis, IN

Research Funding

No funding received
None

Background: Neo-adjuvant therapy is becoming a preferred approach in the management of BR pancreatic cancer patients. There is no consensus on an ideal treatment regimen. We report our experience with a combination of nab-Paclitaxel/Gemcitabine followed by concurrent Capecitabine and radiation treatments in BR pancreatic cancer patients. Methods: A prospectively maintained database of patients with BR pancreatic cancer undergoing neo-adjuvant treatments at our cancer center between 01/2013- 11/2017 was reviewed. Patients were treated with Gemcitabine(1gm/m2) and nab-paclitaxel (125mg/m2) given on D1-8-15 every 28 days. Pts. were re-assessed after two cycles and the responding pts received two additional cycles. Pts. who continued to respond after four cycles were treated with capecitabine (825mg/m2) and radiation treatments(50.4Gy). Results: A total of 32 patients with PS 0/1 were treated. Median age was 59 yrs (42-76), 19 Males and 13 females. After 2 cycles of Gem/nab-paclitaxel, none of the pts. had progressive disease. Thirty patients (93%) were able to complete all four cycles of Gem/nab-paclitaxel. Twenty nine (90%) received capecitabine and radiation treatments. Imaging to assess response was done 4 weeks after completing radiation and the results were were; 2 CR, 11 PR, 14 SD, 2 PD. Surgery was performed 6-8 weeks after completing radiation. Twenty six (81%) underwent planned resection, 2 had PD, 3 declined surgery and 1 had significant decline in PS. Twenty two out of Twenty six patients undergoing surgery had a R0 resection (80%). Grade-III/IV toxicities with the neo-adjuvant treatments were seen in 41% and 7 % of the pts., respectively. No thirty day post-op mortality, pancreatic leaks or re-operations were observed. The median PFS among all patients was 11.7 months, 2 yr OS 49% and median OS was 27.6 months, compared to 23.4 months, 65% and median OS not reached, in patients who underwent surgical resection. Conclusions: Nab-Paclitaxel and Gemcitabine followed by Capecitabine and radiation is an effective neo-adjuvant treatment strategy with acceptable toxicity-profile for patients with BR pancreatic cancer.

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Abstract Details

Meeting

2020 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Hepatobiliary Cancer, Neuroendocrine/Carcinoid, Pancreatic Cancer, and Small Bowel Cancer

Track

Hepatobiliary Cancer,Neuroendocrine/Carcinoid,Pancreatic Cancer,Small Bowel Cancer,Other GI Cancer

Sub Track

Therapeutics

Citation

J Clin Oncol 38, 2020 (suppl 4; abstr 718)

Abstract #

718

Poster Bd #

L7

Abstract Disclosures