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Invited Commentary
February 2014

Prolonged Preoperative Chemotherapy for Locally Advanced Pancreatic Adenocarcinoma: Curing Cancer or Simply Improving Patient Selection?

Author Affiliations
  • 1Department of Surgery, Kaiser Permanente, Los Angeles, California
JAMA Surg. 2014;149(2):154. doi:10.1001/jamasurg.2013.2719

Pancreas adenocarcinoma continues to be a challenge for both clinicians and patients, with relatively few patients being candidates for resection and overall 5-year survival after resection remaining at about 15% to 20%. Much of the recent focus in this field has centered on the use of neoadjuvant chemotherapy to improve patient outcomes.

The study by Kadera et al1 suggests that prolonged administration of preoperative systemic chemotherapy results in better outcomes for locally advanced, unresectable pancreas adenocarcinoma. During a period of nearly 20 years, 49 patients with unresectable pancreas cancer were rendered resectable—mostly without vein resection—by using preoperative chemotherapy for a relatively prolonged period. The results of this study are impressive: three-fourths of patients had node-negative tumors, 85% had negative surgical margins, and more than half had a complete or near-complete histopathologic response. The 5-year survival was almost astonishing: more than 40%. This compares very favorably with conventional modern approaches with adjuvant therapy using either postoperative chemoradiation or gemcitabine-based chemotherapy alone, with a 5-year survival rate of approximately 20%.