Abstract：
:Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with limited effective therapeutic options and exceedingly high mortality rates. Currently, cure can only be achieved through resection, however the vast majority of patients present with advanced disease for which upfront surgery is not an option. In an effort to improve surgical candidacy, neoadjuvant chemotherapy, with or without radiation therapy, is often used in an effort to downstage borderline resectable and locally advanced tumors, and some argue for its use even in patients with resectable tumors. Underlying this thinking is the recognition that pancreatic cancer is simultaneously both a locally invasive and systemic disease, even in patients without evidence of metastasis on imaging. Current evidence to date is largely retrospective, but suggests that neoadjuvant therapy can increase R0 (pathologically negative margin) resection rates and improve overall survival. The standard approach to neoadjuvant treatment involves choosing between the two most active combination regimens for metastatic disease, namely modified FOLFIRNOX and gemcitabine/nab-paclitaxel. Nonrandomized data indicate that these regimens can yield resection rates up to 68% and 36%, in borderline resectable and locally advanced PDAC, respectively. Furthermore, randomized data in patients with resectable PDAC treated with gemcitabine-based neoadjuvant therapy suggests that despite an approximate 10% drop in resection rates, there is a significant improvement in median overall survival. Herein, we will discuss the rationale for neoadjuvant therapy, current and former treatment regimens, common issues faced by clinicians when using these combinations, and several ongoing clinical trials.
journal_name
Semin Oncoljournal_title
Seminars in oncologyauthors
Raufi AG,Manji GA,Chabot JA,Bates SEdoi
10.1053/j.seminoncol.2018.12.002subject
Has Abstractpub_date
2019-02-01 00:00:00pages
19-27issue
1eissn
0093-7754issn
1532-8708pii
S0093-7754(18)30260-4journal_volume
46pub_type
杂志文章,评审abstract：:In patients with recurrent, previously irradiated head and neck cancer, the traditional therapy of palliative single- or multi-agent chemotherapy yields a 30% to 40% response rate with median survival durations of 8 to 10 months. However, long-term survival is rarely observed. Reirradiation with or without concurrent ...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/j.seminoncol.2004.09.003
更新日期：2004-12-01 00:00:00
abstract：:Small cell carcinoma (SCC) has become recognized as a distinct, though relatively infrequent, clinical pathology that occurs in multiple sites throughout the head and neck. Excluding cases that are considered to arise from skin, SCC in the head and neck has been found to develop in nearly all structures associated wit...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/j.seminoncol.2006.10.024
更新日期：2007-02-01 00:00:00
abstract：:The options available to patients with advanced non-small cell lung cancer (NSCLC) resistant or refractory to first-line chemotherapy are very limited. The older-generation drugs (etoposide, vindesine, epirubicin, and cisplatin) that are active against previously untreated NSCLC do not achieve a response rate greater ...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：
更新日期：1998-06-01 00:00:00
abstract：:Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) appears to be one of the most active drugs in the treatment of advanced head and neck cancer. The maximum tolerated dose of paclitaxel in combination with carboplatin is currently being evaluated in phase I/II studies. We designed a phase II study to eval...
journal_title：Seminars in oncology
pub_type： 临床试验,杂志文章
doi：
更新日期：1997-02-01 00:00:00
abstract：:This ongoing study was initiated to determine the feasibility of administering amifostine (Ethyol, WR-2721; MedImmune, Inc, Gaithersburg, MD) with monomodal high-dose rate (mHDR) brachytherapy and to assess the tolerability and side effects of this combination. To date, 18 patients suitable for prostate implant brachy...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/j.seminoncol.2003.11.010
更新日期：2003-12-01 00:00:00
abstract：:Bendamustine has clinical potential in the treatment of low-grade non-Hodgkin's lymphoma (NHL). As a single agent, bendamustine has been used in two studies in patients with relapsed or refractory low-grade NHL. When bendamustine 120 mg/m(2) was given on days 1 and 2, the overall response rate was 73% with complete re...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/sonc.2002.34877
更新日期：2002-08-01 00:00:00
abstract：:Multitargeted antifolate (MTA, LY231514) is a novel antifolate antimetabolite, with antitumor activity via inhibition of thymidylate synthase, glycinamide formyl transferase, and dihydrofolate reductase. Three dosing schedules have been investigated in the phase I setting: daily x5 every 21 days, weekly x4 every 42 da...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：
更新日期：1999-04-01 00:00:00
abstract：:This phase I trial was designed to determine the maximum tolerated dose of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) given as a 3-hour infusion in combination with carboplatin (400 mg/m2) as first-line chemotherapy for stage IIIC/IV ovarian adenocarcinoma. After premedication, paclitaxel was infu...
journal_title：Seminars in oncology
pub_type： 临床试验,杂志文章
doi：
更新日期：1996-10-01 00:00:00
abstract：:Inflammatory breast cancer (IBC) is the most aggressive form of breast cancer, often presenting with distant metastasis. While controversy exists regarding the actual incidence of the disease, there is agreement that IBC causes a disproportionate number of breast cancer deaths. Those with typical IBC symptoms face a h...
journal_title：Seminars in oncology
pub_type： 杂志文章
doi：10.1053/j.seminoncol.2007.11.011
更新日期：2008-02-01 00:00:00
abstract：:Predicting which patients with primary melanoma are at risk of developing metastastic disease is important for making rational therapeutic decisions. Tumor thickness alone is the most commonly used predictor of survival, but other clinical and pathologic variables also play an important role. We have developed two mul...
journal_title：Seminars in oncology
pub_type： 杂志文章
doi：
更新日期：1997-02-01 00:00:00
abstract：:Because patients with metastatic bone disease suffer a significant burden from their illness and from anticancer treatments, it is therefore important to minimize the side effects of bisphosphonates. The intravenous bisphosphonates, zoledronic acid and pamidronate, have tolerability issues that include a flu-like synd...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/j.seminoncol.2004.07.030
更新日期：2004-10-01 00:00:00
abstract：:CEP (CCNU, etoposide, and prednimustine) was tested as third-line chemotherapy in 40 patients resistant to both MOPP and ABVD. The observed response rate (complete remission, 35%, and partial remission, 25%) is encouraging. Treatment was generally well tolerated and all acute side effects were reversible. ...
journal_title：Seminars in oncology
pub_type： 杂志文章
doi：
更新日期：1985-03-01 00:00:00
abstract：:One hundred fifty-six patients with metastatic or locally advanced non-small cell lung cancer (NSCLC) were randomized to 3-week cycles of treatment with either: (A) cisplatin (120 mg/m2 on day 1); (B) cisplatin (120 mg/m2 on day 1) plus etoposide (VP-16) (100 mg/m2 on days 1-3; and (C) the cisplatin plus etoposide (VP...
journal_title：Seminars in oncology
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1988-12-01 00:00:00
abstract：:Gemcitabine is a novel nucleoside analogue that has demonstrated activity against several solid tumors. A large phase II study has been performed in Europe and Canada with a total enrollment of 161 non-small cell lung cancer patients, 26 of whom were from the Institut Gustave-Roussy. Patient characteristics were the s...
journal_title：Seminars in oncology
pub_type： 临床试验,杂志文章,多中心研究
doi：
更新日期：1997-04-01 00:00:00
abstract：:Colorectal cancer is an ideal model in which to study malignant progression from the molecular-genetic perspective because different stages of the same malignancy coexist within each patient. Approximately 75% of colorectal cancer cases are sporadic and the remaining are familial disease, yet genetic mutations that ha...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/j.seminoncol.2006.10.003
更新日期：2006-12-01 00:00:00
abstract：:The side effects of cisplatin (75 mg/m2) in combination with paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) (175 mg/m2 over 3 hours) are expected to be more severe and frequent than those of carboplatin (area under the concentration-time curve of 5) in combination with the same dose of paclitaxel, but...
journal_title：Seminars in oncology
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1997-10-01 00:00:00
abstract：:This randomized, multinational, multicenter study was designed to determine the response rate of gemcitabine monotherapy and cisplatin/etoposide combination therapy in chemotherapy-naive patients with advanced, recurrent, and/or metastatic non-small cell lung cancer (stage IIIA [if inoperable], IIIB, or IV). One group...
journal_title：Seminars in oncology
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：
更新日期：1997-06-01 00:00:00
abstract：:In the United States there are approximately 100,000 women living with metastatic breast cancer. Bone is the most common site of breast cancer metastases and it is estimated that up to 85% of patients dying from this disease have developed osseous involvement. Skeletal metastases are often associated with dangerous an...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/sonc.2001.25445
更新日期：2001-08-01 00:00:00
abstract：:Chemotherapy for prostate cancer currently has an established role in the treatment of hormone-refractory prostate cancer. There is strong evidence that combined modality treatment with androgen ablation in addition to radiotherapy provides a benefit above and beyond radiotherapy alone in patients with a poor prognosi...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1016/s0093-7754(03)00274-4
更新日期：2003-08-01 00:00:00
abstract：:We studied the efficacy of endoscopic variceal ligation (EVL) in 16 patients with tumor thrombus of the portal vein trunk (Vp3) associated with hepatocellular carcinoma. The average (+/-SD) number of O rings used was 9.0 +/- 5.0 for the esophageal varices (n = 7) and 16.4 +/- 4.5 for the esophagogastric varices (n = 9...
journal_title：Seminars in oncology
pub_type： 杂志文章
doi：
更新日期：1997-04-01 00:00:00
abstract：:Recent data indicate that cellular immune responses can produce an anticancer effect. Two types of cellular immune responses appear to be clinically relevant: antigen specific immunity mediated by T cells that recognize tumor-associated peptide antigen expressed on surface HLA class I or class II molecules, and antige...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/j.seminoncol.2004.02.021
更新日期：2004-04-01 00:00:00
abstract：:Evidence published during several decades has shown that there is a group of epithelial ovarian tumors having histological and biological features between those of clearly benign and frankly malignant tumors. In 1963, FIGO accepted an intermediate group of ovarian carcinomas of low malignant potential. In 1973, WHO ad...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：
更新日期：1998-06-01 00:00:00
abstract：:Lung cancer represents the leading cause of cancer mortality worldwide. Its incidence has declined in men but is increasing in women, assuring that this largely preventable disease will continue to affect millions. In small cell lung cancer, the advent of chemotherapy in the 1970s and continued refinements in the 1980...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：
更新日期：1997-08-01 00:00:00
abstract：:Pharmacologic interventions for cancer risk reduction involve the chronic administration of synthetic or natural agents to reduce or delay the occurrence of malignancy. Despite the strong evidence for a favorable risk-benefit ratio for a number of agents in several common malignancies such as breast and prostate cance...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/j.seminoncol.2015.09.014
更新日期：2016-02-01 00:00:00
abstract：:Intraoperative lymphatic mapping and selective lymphadenectomy for solid malignancies is a novel technique, having been introduced into surgical practice in the last 12 years. Dissemination of this technique among surgeons has followed a course similar to that found with the introduction of new laparoscopic techniques...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/j.seminoncol.2004.03.005
更新日期：2004-06-01 00:00:00
abstract：:Selective aromatase inhibitors cause regression of breast carcinomas by reducing estrogen production via inhibition of the enzyme aromatase (estrogen synthetase). A higher incidence of hormone-dependent breast cancer occurs in postmenopausal women than in younger women. Thus, total estrogen blockade is more likely to ...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：
更新日期：1996-08-01 00:00:00
abstract：:Hepatic metastases are a major cause of mortality in patients with colorectal carcinoma. The rationale for regional therapy is presented. The randomized studies are reviewed and they demonstrated a significantly higher response rate with hepatic arterial therapy versus systemic therapy. Survival information is difficu...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：
更新日期：1992-04-01 00:00:00
abstract：:Fludara I.V. (fludarabine phosphate) (9-beta-D-arabinosyl-2-fluoroadenine, F-ara-A) is an adenine nucleoside analogue resistant to adenosine deaminase that shows promising therapeutic activity in the clinical treatment of lymphocytic hematologic malignancies. F-ara-A is transported into cells, where it is converted to...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：
更新日期：1990-10-01 00:00:00
abstract：:Although more common in developing countries, over 11,000 deaths will occur in the United States from head and neck cancer in 2004. Squamous cell carcinomas account for the vast majority of cases in the United States and the majority of these are related to exposure to tobacco and alcohol. Newer data suggest a genetic...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：10.1053/j.seminoncol.2004.09.013
更新日期：2004-12-01 00:00:00
abstract：:The epidemiologic literature suggests that environmental exposures, familial susceptibility, and cytogenetic changes affect AML risk in childhood and adulthood. Unfortunately, many studies are limited by inadequate sample sizes, imprecise case definition, or inadequate exposure measurement. Few studies have singled ou...
journal_title：Seminars in oncology
pub_type： 杂志文章,评审
doi：
更新日期：1987-12-01 00:00:00
