Neoadjuvant gemcitabine and nab‐paclitaxel for borderline resectable pancreatic cancers: Intention‐to‐treat analysis compared with upfront surgery

Background/Purpose We evaluated efficacy of neoadjuvant therapy with gemcitabine and nab‐paclitaxel (GNP‐NAT) in borderline resectable pancreatic cancer (BR‐PC) patients compared to conventional upfront surgery (UPS). Methods This single‐center retrospective study assessed 151 consecutive patients: 96 diagnosed in 2008‐2014 underwent UPS (UPS group) and 55 diagnosed in 2015‐2017 underwent GNP‐NAT (GN group). Patient background, surgical, pathological, and survival outcomes were compared between groups. Results Age, sex, and pretreatment carbohydrate antigen 19‐9 were similar between groups. After four courses of NAT‐GNP, 46 GN patients (84%) underwent surgery while all UPS patients underwent surgery. Only three GN patients (5%) underwent non‐therapeutic procedures, compared to 23 (24%) in the UPS group (P = .004). In the whole cohort, R0‐resection was achieved in 40 GN patients (73%) vs 46 UPS patients (48%; P = .004) and the 3‐year overall survival was significantly higher in the GN group (median survival time, 31.9 vs 18.1 months, P = .014). In the resection cohort, the R0‐resection rate was 93% (GN) vs 63% (UPS; P = .0007). There was no 90‐day mortalities in either group. Conclusions Intention‐to‐treat‐based analysis indicated considerable benefits of GNP‐NAT in BR‐PCs for long‐term survival, contributing to improved tumor suppression and patient selection. Highlight Inoue and colleagues compared the short‐ and long‐term outcomes of neoadjuvant gemcitabine and nab‐paclitaxel therapy with those of conventional upfront surgery for borderline pancreatic cancers. Intention‐to‐treat‐based analysis revealed significant benefits of neoadjuvant therapy for long‐term survival, providing improved tumor suppression and patient selection, allowing aggressive surgical procedures with similar safety.