In 30%–40% of patients, pancreatic cancer presents as locally advanced disease (LAPC) in which the tumour is unresectable due to vascular involvement.
In this setting, the aim of treatment is to induce tumour downsizing to facilitate resection in patients with initially unresectable disease.
The evidence-based strategy centres on conversion (induction) therapy — a structured course of combination chemotherapy designed to downstage the tumour and potentially open a path to surgical resection. The full regimen, duration, and sequencing are detailed in the complete protocol.
Response is assessed by a significant decrease in CA 19-9 level, clinical improvement, and tumour downstaging. All patients are evaluated for resectability at regular intervals throughout the treatment course.
DOI: 10.1016/j.annonc.2023.08.009
In 30%-40% of patients, the tumour is unresectable due to vascular involvement.
In LAPC, the purpose of conversion (or induction) therapy is to induce tumour downsizing to facilitate resection in patients with initial unresectable disease.
A conversion surgery strategy utilising the standard of care of (up to) 6 months of combination ChT (FOLFIRINOX or GN) can be chosen [I, B]; GN is not EMA or FDA approved for LAPC.
Exploration for resection could be discussed if there is a significant decrease in CA 19-9 level, clinical improvement and tumour downstaging [IV, B].
All patients must be evaluated by the local MDTB for resectability every 2-3 months [III, A].
View source ↗