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Concurrent Nab-paclitaxel and Radiotherapy: Novel Radiosensitization for Borderline Resectable or Unresectable Pancreatic Cancer.

Concurrent Nab-paclitaxel and Radiotherapy: Novel Radiosensitization for Borderline Resectable or Unresectable Pancreatic Cancer.

Authors :
Arscott WT
Nead KT
Bear A
Venigalla S
Shabason J
Lukens JN
Plastaras JP
Wojcieszynski A
Metz J
O'Hara M
Reiss KA
Teitelbaum U
Loaiza-Bonilla A
Drebin J
Lee MK 4th
Shroff SG
Ben-Josef E
Source :
American journal of clinical oncology [Am J Clin Oncol] 2021 Sep 01; Vol. 44 (9), pp. 469-474.
Publication Year :
2021

Abstract

Purpose: This study evaluates the toxicity and tumor response with concurrent nab-paclitaxel chemoradiotherapy (CRT) compared with standard (5-fluorouracil or gemcitabine) CRT.<br />Materials and Methods: Fifty patients with borderline resectable or unresectable pancreatic adenocarcinoma from 2014 to 2017 were divided into 2 groups: concurrent nab-paclitaxel (100 to 125 mg/m2 weekly) CRT (median: 2.1 Gy fraction size and 52.5 Gy total) or standard CRT (median: 1.8 Gy fraction size, 54.5 Gy total). The primary endpoint was toxicity, and secondary endpoints were local failure and conversion to resectability. Comparisons were made using rank-sum or Fisher exact test and multivariable competing risk regression for the cumulative incidence of local failure.<br />Results: There were 28 patients in the nab-paclitaxel CRT group and 22 in the standard CRT group; 88% had the unresectable disease. The median follow-up was 18 months. The median duration of chemotherapy before concurrent CRT was 1.9 and 2.3 months in the nab-paclitaxel and standard CRT groups (P=0.337), and radiotherapy dose was 52.5 Gy (range, 52.5 to 59.4 Gy) and 54.5 Gy (range, 45.0 to 59.4 Gy), respectively. There were no statistically significant grade ≥2 toxicities. The nab-paclitaxel CRT group experienced a nonstatistically significant lower incidence of local failure (hazard ratio=0.91, 95% confidence interval: 0.27-3.03, P=0.536). More patients in the nab-paclitaxel CRT group proceeded to surgery (9/28 compared with 3/22 in the standard CRT, P=0.186); of which 6 (25%) in the nab-paclitaxel CRT and 2 (10%) in the standard CRT groups were initially unresectable.<br />Conclusions: Nab-paclitaxel CRT had similar toxicity compared with standard CRT in the treatment of borderline resectable or unresectable pancreatic cancer. Its use was associated with an arithmetically lower cumulative incidence of local failure and an arithmetically higher conversion to resectability, both of which were not statistically significant.<br />Competing Interests: A.L.-B. reports personal fees from Celgene outside the submitted work. The other authors declare no conflicts of interest.<br /> (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Details

Language :
English
ISSN :
1537-453X
Volume :
44
Issue :
9
Database :
MEDLINE
Journal :
American journal of clinical oncology
Publication Type :
Academic Journal
Accession number :
34310350
Full Text :
https://doi.org/10.1097/COC.0000000000000854