Citations 2
Best Practices for Delivering Neoadjuvant Therapy in Pancreatic Ductal Adenocarcinoma
Cloyd, Jordan M. , Sarna, Angela, Arango, Matthew J. , Bates, Susan E. , Bloomston, Mark, Ferrone, Cristina R., Gambino, Patricia, Goenka, Ajit H. , Hall, William A. , Jayaraman, Shiva , Kambadakone, Avinash, Ko, Andrew , Kooby, David A. , Krishna, Somashekar G. , Larsson, Liliana, Massarweh, Nader N. , Mikhail, Sameh , Palta, Manisha , Petzel, Maria Q. B., Philip, P. A., Mina, Daniel Santa , Sohal, Davendra , Sundaresan, Tilak , Tsai, Susan, Vreeland, Timothy J. , Walston, Steve, Wo, Jennifer Y. , Snyder, Rebecca A. , He, Jin , Tsai, Susan , Krishna, Somashekar G , Santa Mina, Daniel , Bates, Susan E , Bhutani, Manoop S. , Chung, Vincent , Dotan, Efrat , Goodman, Karyn A. , He, Jing , Hogg, Melissa E. , Katz, Matthew H. G. , Khorana, Alok A. , Koay, Eugene J. , Lee, Richard T. , Maitra, Anirban , Muzaffar, Mahvish , O’Reilly, Eileen M. , Reyngold, Marsha , Turner, Kea L. , Washington, Mary Kay , Williams, Terence M. , Snyder, Rebecca A.
JAMA Surgery | December 4, 2024 | Volume: 160 | Issue: 2 | Pages: 172
Importance Neoadjuvant therapy (NT) is an increasingly used treatment strategy for patients with localized pancreatic ductal adenocarcinoma (PDAC). Little research has been conducted on cancer care delivery during NT, and the standards for optimal delivery of NT have not been defined. Objective To develop consensus best practices for delivering NT to patients with localized PDAC. Design, Setting, and Participants This study used a modified Delphi approach consisting of 2 rounds of voting, and a series of virtual conferences (from October to December 2023) to reach expert consensus on candidate best practice statements generated from a systematic review of the literature and expert opinion. An interdisciplinary panel was formed including 47 North American experts from surgical, medical, and radiation oncology, radiology, pathology, gastroenterology, integrative oncology, anesthesia, pharmacy, nursing, cancer care delivery research, and nutrition as well as patient and caregiver stakeholders. Main Outcome and Measures Statements that reached 75% agreement or greater were included in final consensus statements. Results Of the 47 participating panel members, 27 (57.64%) were male, and the mean (SD) age was 47.6 (8.2) years. Physicians reported completing training a mean (SD) 14.6 (8.6) years prior and seeing a mean (SD) 110.6 (38.4) patients with PDAC annually; 35 (77.7%) were in academic practice. Final consensus was reached on 82 best practices for delivering NT. Of these, 38 statements focused on pre-NT practices, including diagnosis and staging (n = 15), evaluation and optimization (n = 20), and decision-making (n = 3); 29 statements defined best practices during NT, including initiation (n = 3), delivery of therapy (n = 8), restaging practices (n = 12), and management of complications during NT (n = 6); and 15 best practices were identified to guide treatment post-NT, focusing on surgery (n = 7), pathology (n = 4), and follow-up (n = 3). Conclusions Using a modified Delphi consensus technique, best practice guidelines were developed focusing on the optimal standards for delivering NT to patients with localized PDAC. Given the prognostic importance of completing multimodality therapy, efforts to standardize and optimize the delivery of NT represent an immediate opportunity to decrease care variation and improve outcomes for patients with PDAC. Future research should focus on validating and implementing best practice standards into clinical practice.
Postdiagnosis Loss of Skeletal Muscle, but Not Adipose Tissue, Is Associated with Shorter Survival of Patients with Advanced Pancreatic Cancer
Babić, Ana , Rosenthal, Michael H. , Bamlet, William R. , Takahashi, Naoki , Sugimoto, Motokazu , Danai, Laura V. , Morales‐Oyarvide, Vicente, Khalaf, Natalia , Dunne, Richard F. , Welch, Marisa W., Zellers, Caitlin L., Dennis, Courtney , Rifai, Nader , Prado, Carla M. , Caan, Bette J. , Sundaresan, Tilak , Meyerhardt, Jeffrey A. , Kulke, Matthew H. , Clish, Clary B. , Ng, Kimmie , Petersen, Gloria M. , Wolpin, Brian M. , Vander Heiden, Matthew G , Bamlet, William R , Meyerhardt, Jeffrey A , Clish, Clary , Takahashi, Naoki , Caan, Bette J , Brais, Lauren K
Cancer Epidemiology, Biomarkers & Prevention | September 18, 2019 | Volume: 28 | Issue: 12 | Pages: 2062-2069
Abstract Background: Pancreatic cancer is associated with development of cachexia, a wasting syndrome thought to limit survival. Few studies have longitudinally quantified peripheral tissues or identified biomarkers predictive of future tissue wasting. Methods: Adipose and muscle tissue were measured by computed tomography (CT) at diagnosis and 50 to 120 days later in 164 patients with advanced pancreatic cancer. Tissue changes and survival were evaluated by Cox proportional hazards regression. Baseline levels of circulating markers were examined in relation to future tissue wasting. Results: Compared with patients in the bottom quartile of muscle change per 30 days (average gain of 0.8 ± 2.0 cm2), those in the top quartile (average loss of 12.9 ± 4.9 cm2) had a hazard ratio (HR) for death of 2.01 [95% confidence interval (CI), 1.12–3.62]. Patients in the top quartile of muscle attenuation change (average decrease of 4.9 ± 2.4 Hounsfield units) had an HR of 2.19 (95% CI, 1.18–4.04) compared with those in the bottom quartile (average increase of 2.4 ± 1.6 Hounsfield units). Changes in adipose tissue were not associated with survival. Higher plasma branched chain amino acids (BCAA; P = 0.004) and lower monocyte chemoattractant protein-1 (MCP-1; P = 0.005) at diagnosis were associated with greater future muscle loss. Conclusions: In patients with advanced pancreatic cancer, muscle loss and decrease in muscle density in 2 to 4 months after diagnosis were associated with reduced survival. BCAAs and MCP-1 levels at diagnosis were associated with subsequent muscle loss. Impact: BCAAs and MCP-1 levels at diagnosis could identify a high-risk group for future tissue wasting.