Efficacy and safety of chemoradiotherapy using gemcitabine plus nab-paclitaxel for unresectable locally advanced pancreatic cancer

Abstract Using chemotherapy or chemoradiotherapy (CRT) as the main treatment strategy for unresectable locally advanced pancreatic ductal adenocarcinoma (UR-LA PDAC) remains controversial. This study aimed to evaluate the efficacy and safety of CRT combined with gemcitabine plus nab-paclitaxel in patients with UR-LA PDAC. Eight patients with UR-LA PDAC were eligible for inclusion. Nab-paclitaxel (100 mg/m²) and gemcitabine (800 mg/m² or 1000 mg/m²) were administered on days 1 and 8 per 3-week cycle repeated for two cycles with concurrent radiation therapy (50.4 Gy/28 fractions/6 weeks). After this regimen was administered, conversion surgery was considered if the tumor was reduced in size, and we judged the tumor to be resectable. No CRT-related mortality was observed during CRT. Three patients failed to complete this regimen because of neutropenia and hepatic impairment. The treatment completion and resection rates were 62.5% (5/8) and 25.0% (2/8), respectively. Curative resection (R0) was performed in two patients (100%). The 1-and 3-year overall survival rates were 37.5% and 25.0%, respectively, with a median follow-up period of 355 (range, 226 − 1450) days. CRT with 100 mg/m² nab-paclitaxel and 800 mg/m² gemcitabine with 50.4 Gy radiation was well tolerated and safe,but most UR-LA PDAC patients require additional treatment, suggesting CRT limitations.