Resectable Pancreatic Cancer Debate: Total Neoadjuvant vs Adjuvant Therapy - Adjuvant Therapy

[@JuanDiazSilvermyst]

Jesus... 😢 Even more reason why we need funding to raise the survival rate. This is scary

[@khaliddurrani6432]

The actual debate is about the use of neo-adj treatment in resectable or borderline resectable cases. One could argue both ways ie in favor or against it. Pro -1. Chance of higher R0 resection and N0 yields. 2. Micro mets are dealt with at an early stage. 3. Tests the biology of the disease before a major complex procedure of pancreatic resection. So this may help in the selection of patients suitable for resection. Cons-1. Surgery is only definitive potentially curative therapy In cancer. Tumor Progression in the refractory cases may delay surgery and result in inoperability. 2. Increased toxicity may lead to termination of therapy and or delay surgery. 3. Neo adj chemo may change the genetic signature of the cancer hence denying the benefit of specified immunotherapy. 4. Both local as well as distant failures are common even with chemo both in the neo adj as well as adj setting. So a significant no of patients will be subjected to chemo and its toxicity ( chemical financial) without any benefit. 5. The growth factors released after surgery may increase the growth of tumor if Adj chemo is not given. 6. The chemo given in PREOPANC trial is gem/A whereas presently the standard of Adj is FOLFIRINOX. 7. Any pre-op treatment will necessitate a stent to relieve jaundice. This is associated with infection and higher peri-op complications.

[@drhannibal.lecter]

couldn't be more succinct

[@bobmcnelis3648]

Definitely not a video for patients!

[@marysaunders1770]

Technically I didn't have pancreatic cancer but ampullary tumour, however treatment is the same. Had whipple procedure February 2021, and adjuvant chemotherapy. I plan to live longer than 5 years....thanks ❤🧡💛💚 Huge thanks to #andreasprachalis for my surgery.

[@fredfittin9434]

Dismal outlook beyond the help of the experts…

[@leewalsh2428]

I was diagnosed with Pancan at the beginning of December 2021aged 65, I have just started a 12 cycle course of Neoadjuvant folfirinox chemotherapy (Adenocarcinoma of uncinate process of the head of the pancreas) borderline operable and intermediate right lobe upper nodule 25% SMV and less than 25% SMA, is folfirinox effective for shrinking a tumour off the SMV and SMA blood vessels.

[@khaliddurrani6432]

Pre-op FOLFRINX may cause the tumor to shrink in upto 40% of cases allowing a potentially curative surgery. However in your case the suspicions lesions in the liver are an absolute contraindication to surgery unless mets are ruled out. Wishing you all the best.

[@leewalsh2428]

@@khaliddurrani6432 What suspicions lesions in the liver? as far as I'm aware my cancer is locally advanced within the pancreas IE- it has spread to 25% of my Superior mesenteric vein and less than 25% to my Superior mesenteric artery, I have intermediate right lobe upper nodule in my lung but my oncologist is unconcerned with it.

[@guruprasad7184]

@@leewalsh2428 ..how are you doing now with chemo?Please your reply saves someone's hope and life here

[@JJ21210]

@@guruprasad7184 I encourage you to read the Pancreatic Cancer board on Mayo Clinic Connect -- lots and lots of threads, with active participation daily. You're also welcome to post question and comments. I hope you're OK.