58 |
FIGURE 1. SCHEMA FOR SWOG TRIAL 1505
sufficient to facilitate a margin-negative resection.
•Patients with rapidly progressive
cancers may be spared a
presumably futile operation
if they are found to develop
metastases during systemic
therapy before surgery.
Several single-arm studies
have shown that both
chemotherapy and radiation
can generally be delivered
safely before pancreatectomy.
Although the outcomes
associated with this general
strategy have not been shown
to be superior to the standard
“surgery first” regimen,
preoperative therapy has gained
popularity nationwide both
for patients with resectable
(low-risk for margin-positive
resection) and borderline
resectable (high-risk for
margin-positive resection)
pancreatic cancers. Encouraging
data using newer systemic
chemotherapy and radiation
regimens have increased
interest in this strategy. Indeed,
two of the three treatment
trials for patients with non-
metastatic pancreatic cancer
that are being conducted
within the National Clinical
Trials Network (NCTN) have
been designed to evaluate and
optimize preoperative therapy
regimens for patients with
localized pancreatic cancer.
Trials under way
Until recently, systemic
therapy options in pancreatic
cancer have been limited and
relatively ineffective, thus
limiting opportunities for
preoperative therapy. Now with
Pancreatic
adenocarcinoma
Registration and randomization
Arm 1: mFOLFIRINOX
( 3 cycles)
Arm 2: Gemcitabine/nab-paclitaxel
( 3 cycles)
Restaging Restaging
No progression No progression Progression Progression
Surgery Surgery Off treatment Off treatment
mFOLFIRINOX
( 3 cycles)
Gemcitabine/nab-paclitaxel
( 3 cycles)
Off treatment Off treatment