ACS Bulletin - August 2016

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