International Session（Symposium）6(JSGE・JGES・JSGS・JSGCS)
Fri. November 6th   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
IS-S6-4_G
 Neoadjuvant therapy for resectable/borderline pancreatic cancer.
Michiaki Unno
Department of Surgery, Tohoku University Graduate School of Medicine
Up-front surgery followed by adjuvant chemotherapy were regarded as one of the standard therapy in patients with resectable/borderline resectable pancreatic cancer. However, these prognoses were very poor.
First, neoadjuvant therapy for borderline resectable pancreatic cancer was accepted because the R0 resection rate was extremely low. A lot of clinical studies have bee done, but a lot of undissolved issues such as best regimen, timing, with or without irradiation, and surgical indication are unclear. The biggest problem is the fact that even with neoadjuvant therapy, the outcomes are not satisfactory.
For resectable pancreatic cancer, there was no evidence of neoadjuvant therapy. Last year, we reported the results of the randomized control trial, Prep02/JSAP05. A total of 362 patients were randomly assigned to the neoadjuvant group with Gemcitabine +S-1 (NAC-GS; n=182) or upfront surgery (Up-S; n=180) for three years (2013-16). The median OS was 36.7 months in NAC-GS and 26.6 months in UP-S; HR 0.72 (p=0.015, stratified log-rank test). The phase III study demonstrated that the significant survival benefits of NAC-GS. In October 2019, the Japanese guidelines for pancreatic cancer had been revised to recommend neoadjuvant therapy for resectable pancreatic cancer.
Index Term 1: pancreatic cancer
Index Term 2: Neoadjuvant chemotherapy
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