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Attend this session at the
2019 ASCO Annual Meeting!

Session: Gastrointestinal (Noncolorectal) Cancer

Type: Poster Session

Time: Monday June 3, 8:00 AM to 11:00 AM

Location: Hall A

Variation in the surgical management of locally advanced pancreatic cancer.

Pancreatic Cancer

Gastrointestinal (Noncolorectal) Cancer

2019 ASCO Annual Meeting

Abstract No:

Poster Board Number:
Poster Session (Board #227)

J Clin Oncol 37, 2019 (suppl; abstr 4122)

Author(s): Bradley Norman Reames, Alex Blair, Robert Wallace Krell, James Padussis, Sarah P. Thayer, Massimo Falconi, Christopher Lee Wolfgang, Matthew J. Weiss, Chandrakanth Are, Jin He; University of Nebraska Medical Center, Omaha, NE; Johns Hopkins University, Baltimore, MD; Memorial Sloan Kettering Cancer Center, New York, NY; Chirurgia, Verona, Italy; Johns Hopkins University School of Medicine, Baltimore, MD

Abstract Disclosures


Background: Recent reports suggest patients with locally advanced pancreatic cancer (LAPC) may become candidates for curative resection following neoadjuvant therapy, with encouraging survival outcomes. Yet the optimal management approach for LAPC remains unclear. We sought to investigate surgeon preferences for the management of patients with LAPC. Methods: An extensive electronic survey was systematically distributed by email to an international cohort of pancreas surgeons. Data collected included surgeon practice characteristics, preferences for staging and management, and 6 clinical vignettes (with detailed videos of post-neoadjuvant arterial and venous imaging) to assess attitudes regarding eligibility for surgical exploration. Results: A total of 150 eligible responses were received from 4 continents. Median duration in practice was 12 years (IQR 6-20) and 75% respondents work in a university setting. Most (84%) are considered high volume, 33% offer a minimally-invasive approach, and 48% offer arterial resection in selected patients. A majority (70%) always recommend neoadjuvant chemotherapy, and 62% prefer FOLFIRINOX. Preferences for duration of neoadjuvant therapy varied widely: 39% prefer ≥2 months, 41% prefer ≥4 months, and 11% prefer 6 months or more. Forty-one percent frequently recommend neoadjuvant radiation, and 51% prefer standard chemoradiotherapy. Age ≥80 years and CA 19-9 of ≥1000 U/mL were commonly considered contraindications to exploration. In 5 clinical vignettes of LAPC, the proportion of respondents that would offer exploration following neoadjuvant varied extensively, from 15% to 54%. In a vignette of oligometastatic pancreatic liver metastases, 32% would offer exploration if a favorable biochemical and imaging response to therapy is observed. Conclusions: In an international cohort of high volume pancreas surgeons, there is substantial variation in attitudes regarding staging preferences and surgical management of LAPC. These results underscore the importance of coordinated multi-disciplinary care, and suggest an evolving concept of “resectability.” Patients and their oncologists should have a low threshold to consider a second opinion for the surgical management of LAPC, if desired.

Other Abstracts in this Sub-Category:


1. Olaparib as maintenance treatment following first-line platinum-based chemotherapy (PBC) in patients (pts) with a germline BRCA mutation and metastatic pancreatic cancer (mPC): Phase III POLO trial.

Meeting: 2019 ASCO Annual Meeting Abstract No: LBA4 First Author: Hedy L. Kindler
Category: Gastrointestinal (Noncolorectal) Cancer - Pancreatic Cancer


2. APACT: phase III, multicenter, international, open-label, randomized trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) for surgically resected pancreatic adenocarcinoma.

Meeting: 2019 ASCO Annual Meeting Abstract No: 4000 First Author: Margaret A. Tempero
Category: Gastrointestinal (Noncolorectal) Cancer - Pancreatic Cancer


3. Randomized phase II study of second-line modified FOLFIRI with PARP inhibitor ABT-888 (Veliparib) (NSC-737664) versus FOLFIRI in metastatic pancreatic cancer (mPC): SWOG S1513.

Meeting: 2019 ASCO Annual Meeting Abstract No: 4014 First Author: E. Gabriela Chiorean
Category: Gastrointestinal (Noncolorectal) Cancer - Pancreatic Cancer