What to Do After Induction Therapy in Borderline Resectable Pancreatic Cancer

Borderline resectable pancreatic cancer (BRPC) carries a high probability of a margin-positive (R1) resection if surgery is attempted upfront. This necessitates a sequential approach in which induction treatment precedes any surgical consideration, and a dedicated protocol defines the next step once induction is complete.

Clinical Scenario

Patients with borderline resectable pancreatic cancer have a high probability of an R1 resection and should be considered for induction treatment before surgery is explored.

After Induction Therapy — Reassessment

Following a course of induction chemotherapy — which may include FOLFIRINOX or GN, or alternatively gemcitabine-based combinations, with chemoradiotherapy considered on a case-by-case basis — patients are formally reassessed. Those who remain medically fit, demonstrate no disease progression, and show a decrease in CA 19-9 are candidates to proceed to the next step defined by this protocol.

Next Step — Partial Overview

For eligible patients meeting those post-induction criteria, the protocol addresses a surgical approach to the disease. Whether and how that step proceeds — including the specific conditions under which it is or is not undertaken — is detailed in the full structured protocol. Complete regimen available below ↓

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2023.08.009

Patients with BRPC have a high probability of an R1 resection and should be considered for induction treatment [III, A].

Following induction therapy, medically fit patients without disease progression and with a decrease in CA 19-9 should undergo surgical exploration, unless contraindicated [III, A].

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