At the 2023 ACRO Radiation Oncology Summit, Manisha Palta, MD, Duke Cancer Center, Durham, North Carolina, gave a presentation arguing for the use of radiation therapy in the neoadjuvant setting for patients with pancreatic cancer.

Transcript:

Hi, my name is Manisha Palta. I'm a radiation oncologist at Duke University and at this year's most recent ACRO Radiation Oncology Summit, I gave a talk entitled “Clear as Mud: Approaches to Pancreas Cancer in the Neoadjuvant Setting.” A couple of highlights of the talk was addressing the fact that even in the modern era, we still see both high rates of distant recurrence from pancreas cancer, as well as really high rates of local recurrence. And as we're starting to evaluate the role of radiation, there are kind of 3 key areas that I highlighted as far as defining why we should think about radiation in the neoadjuvant management of pancreas cancer. One is that we see higher rates of R0 resection when radiation is given neoadjuvantly or prior to surgery. And just like with a lot of areas of oncology, when we give treatment prior to surgery, we see higher rates of compliance and better compliance with therapy as well as third, reduced toxicity as well. These are the primary reasons or kind of my argument for why we should be thinking about neoadjuvant therapy.

The key clinical trial that I highlighted to support the data of neoadjuvant therapy were the recently presented long-term results from the PREOPANC study. This was a phase 3 study that looked at patients who had either resectable or borderline-resectable pancreas cancer. And they looked at whether patients did better in terms of overall survival if they went straight to surgery or if they had a modest dose of chemoradiation prior to consideration of surgical resection. And what that trial showed with long-term outcomes just published last year in the Journal of Clinical Oncology, was that patients who received neoadjuvant chemoradiation did better in terms of 5-year overall survival compared to those patients who underwent upfront surgery alone.

We also talked at the meeting about various radiation dose fractionation as far as conventional chemoradiation, a more hypofractionated treatment as was given in the PREOPANC trial, as well as the role of ablative radiation or commonly termed SBRT, stereotactic body radiotherapy.

Given where the data are now, the best data that we have is based on that PREOPANC study that I mentioned, supporting the role of neoadjuvant radiation for the treatment of pancreas cancer. In terms of future directions or areas to be mindful of on the horizon, I think one of the important areas where we see advances from a radiation perspective is the use of advanced technologies. We commented on the role and increasing utilization of things like MRI-LINAC, where there can be better visualization of the cancer as well as the possibility of day-by-day adapting the treatment based on the anatomy of the day. And we also talked about the potential role of proton therapy.

There are a number of ongoing studies that are looking to clarify, especially in this modern era where we have triplet drug therapy like FOLFIRINOX. There's the ongoing PREOPANC-2 that is looking at the role of neoadjuvant FOLFIRINOX versus FOLFIRINOX plus chemoradiation prior to surgical resection. There's also an ongoing Alliance trial that is looking at the role of neoadjuvant systemic therapy compared to an upfront surgery approach.

In the coming years, we will have information and data to help clearly redefine the role of neoadjuvant therapy and particularly the role of neoadjuvant radiation for the treatment of pancreas cancer.

Source:

Palta M. “Clear as Mud: Approaches to Pancreatic Cancer in the Neoadjuvant Setting.” Presented at: Radiation Oncology Summit: ACRO 2023; March 15-18, 2023; Lake Buena Vista, FL.