This has been studied at several institutions in a phase II setting (18)-(22). Our group has completed two gemcitabine based chemoradiation trials in patients

with potentially resectable pancreatic cancer (18),(21). In the 176 patients from both trials (Gem-XRT and Gem-Cis-XRT) isolated tumor progression at the time of preoperative restaging was rare with the rate of local tumor progression precluding surgery 0.6% (1 of 176 patients). We have used a similar preoperative strategy for borderline resectable pancreatic cancer Inhibitors,research,lifescience,medical with the exception that therpay lasts longer prior to planned PD (the original dataset of 176 patients did not include any patients with MDACC criteria for borderline resectability). Since patients with borderline resectable pancreatic cancer (type

A) are at a high risk for margin positive resection and poor survival, these patients are ideal candidates for a prolonged course of preoperative therapy. Treatment schema After reviewing the patient’s pancreas protocol CT scan in a multidisciplinary conference Inhibitors,research,lifescience,medical with radiologists and surgical, medical Inhibitors,research,lifescience,medical and radiation oncologists, patients’ cancers are categorized as borderline resectable types A, B, C or a combination of these. Most patients are candidates for initial gemcitabine based GDC-0941 purchase systemic therapy for 2-4 months. Patients with an ECOG PS of 0-1 are considered for combination chemotherapy, often Inhibitors,research,lifescience,medical with gemcitabine and a platinum agent. A restaging CT scan is reviewed after approximately 8 weeks of systemic therapy and patients with radiographic response or a biochemical response in the presence of stable disease are candidates for more systemic therapy followed by chemoradiation or may proceed to

chemoradiation. After a break of 4-6 weeks from their radiation therapy, patients who continue to show disease stability or response are candidates for surgery. Gemcitabine or capecitabine are the common radiation sensitizers used in this setting. After a break of 4-6 weeks from their radiation therapy, patients who continue to show disease stability or response are candidates for surgery. Given the high rate of systemic Inhibitors,research,lifescience,medical relapse in patients many with resected pancreatic cancer, the “best” systemic therapy available may be applicable in the neoadjuvant setting in selected patients. The recent phase 3 study published by Conroy and colleagues reports on FOLFIRINOX superiority over gemcitabine in the treatment of metastatic pancreatic cancer and has gathered interest (23). 342 patients with a PS of 0 or 1 were randomly assigned to receive FOLFIRINOX or gemcitabine. Six months of chemotherapy were recommended in both groups in patients who had a response. The primary end point was overall survival. The median overall survival was 11.1 months in the FOLFIRINOX group as compared with 6.8 months in the gemcitabine group (hazard ratio for death, 0.57; 95% confidence interval [CI], 0.45 to 0.73; P<0.