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CAN NEOADJUVANT CHEMOTHERAPY BE ADMINISTERED AS SAFELY AND EFFECTIVELY AT OUTSIDE INSTITUTIONS VS LOCALLY IN PATIENTS WITH PANCREATIC DUCTAL ADENOCARCINOMA?
Po Hong Tan
*, Richard Max Miller, Zhi Ven Fong, Melody Pi Yin Tu, Hoe Yan Hor, Mohamad B. Sonbol, Mitesh Borad, Daniel Ahn, Christina Wu, Tanios Bekaii-Saab, Nabil Wasif, Chee-Chee Stucky
Surgical Oncology, Mayo Clinic Phoenix, Mesa, AZ
Introduction Current evidence shows that multimodal therapy and centralized surgical management at high-volume centers leads to improved patient outcomes in patients with pancreatic ductal adenocarcinoma (PDAC). Most teams may prefer that all treatment, including neoadjuvant chemotherapy (NAT), be performed locally, but this may be logistically and financially challenging for patients. However, it is unclear if NAT at an outside institution can be coordinated with equal safety and efficacy compared to NAT received locally. This study aims to evaluate the chemotoxicity rates, surgical exploration rates, and survival outcomes in patients receiving NAT locally vs outside institutions.
Methods Patients with non-metastatic PDAC treated with surgical intent at a single institution cancer center from 2008 to 2024 were included. Only patients treated with multimodal NAT comprising of modified FOLFIRINOX or Gemcitabine/Abraxane were included. Overall survival was evaluated using log-rank tests and Cox proportional hazard models.
ResultsOf 276 patients included, 212 (76.8%) had NAT locally while 64 (23.2%) had NAT at outside institutions. There were no significant differences in patient demographics, tumor size, or CA 19-9 levels. Resectability criteria did not significantly differ by institution. There were 44.8% upfront resectable PDAC locally vs 35.9% at outside institution, and 39.1% borderline resectable PDAC locally vs 29.7% at outside institutions (
p=0.3). Median duration of NAT was 3.5 months locally vs 4.0 months at outside institutions (
p=0.6). Severe chemotoxicity rates were also similar between both groups (25.9% locally vs 34.4% at outside institutions,
p=0.2). Rates of chemotherapy protocol modifications—including dose changes and held cycles, were similar regardless of treatment site (69.3% locally vs 76.0% outside institutions,
p=0.5). Over half of the patients receiving NAT at outside institutions followed-up with the cancer center surgeon at least once midway through NAT. Surgical exploration was carried out in 45.3% of patients received NAT locally vs 54.7% of those receiving NAT at outside institutions, (
p=0.2). Median overall survival was not affected by site of NAT (21.6 months locally vs 22.8 months outside institutions,
p=0.7) (Figure 1).
Conclusion In this study, PDAC patients experienced similar chemotoxicity rates, surgical exploration rates, and overall survival regardless of where they received NAT. This suggests that with careful coordination and attentive follow-up, NAT can be administered closer to patients’ homes without compromising safety and efficacy.
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