Outcomes of Primary Chemotherapy for Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma

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Abstract
In the context of localized pancreatic ductal adenocarcinoma (PDAC), chemotherapy is the preferential induction strategy for locally advanced (LA) and borderline resectable (BR) disease.1-3 The recent steady uptake of primary chemotherapy has been fostered by newly introduced combinations, such as FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan) and gemcitabine plus nanoparticple albumin-bound (nab)–paclitaxel, which demonstrated a high response rate in randomized clinical trials of patients with metastatic disease.4,5 Although the translation of these regimens to earlier stages was empirical, several case series reported encouraging outcomes, with resection rates after primary chemotherapy ranging from 60% to 78%.6-11 However, these data are based on the patient pool selected for surgical exploration and not on the overall number of individuals with new diagnoses. At a collective level, a sizable amount of patients are indeed elderly or present with certain conditions (eg, jaundice, poor hematologic function of poor performance status) that hinder treatment eligibility and enrollment in controlled research protocols.12-14 Furthermore, a limitation of most studies is the inability to determine how many patients receiving primary chemotherapy never qualified for surgery because of treatment discontinuation, disease progression, or death.15-22

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