Efficacy and safety of gemcitabine plus S-1 vs. gemcitabine plus nab-paclitaxel in treatment-na?ve advanced pancreatic ductal adenocarcinoma

Objective:Gemcitabine plus nab-paclitaxel(GnP)is the standard first-line therapy for advanced pancreatic ductal adenocarcinoma(PDAC).S-1,an oral fluoropyrimidine derivative,as compared with gemcitabine,is non-inferior in terms of overall survival(OS)and is associated with lower hematologic toxicity.Accordingly,S-1 is a convenient oral alternative treatment for advanced PDAC.This study was aimed at comparing the efficacy and safety of gemcitabine plus S-1(GS)vs.GnP as first-line chemotherapy for advanced PDAC.Methods:Patients with advanced PDAC who received first-line GS or GnP at the Peking Union Medical College Hospital between March 2011 and November 2022 were evaluated.Results:A total of 300 patients were assessed,of whom 84 received GS and 216 received GnP.The chemotherapy completion rate was higher with GS than GnP(50.0%vs.30.3%,P=0.0028).The objective response rate(ORR)was slightly higher(14.3%vs.9.7%,P=0.35),and the median OS was significantly longer(17.9 months vs.13.3 months,P=0.0078),in the GS group than the GnP group.However,the median progression-free survival(PFS)did not significantly differ between groups.Leukopenia risk was significantly lower in the GS group than the GnP group(14.9%vs.28.1%,P=0.049).Conclusions:As first-line chemotherapy for advanced PDAC,the GS regimen led to a significantly longer OS than the GnP regimen.The PFS,ORR,and incidence of severe adverse events were comparable between the GS and GnP groups.

Chinese Medical Association consensus for standardized diagnosis and treatment of pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms(pNENs)are rare and highly heterogeneous tumors originating from pluripotent stem cells with neuroendocrine differentiation in the pancreas,constituting approximately 3%of all pancreatic tumors.^([1])The global incidence of pNENs has been increasing recently,and most cases are sporadic and more common in women.^([1,2])pNENs are clinically divided into functioning and nonfunctioning tumors depending on whether the tumors are accompanied by a clinical syndrome related to specific hormone overproduction.

Impact of antagonist peptides and chelators on the diagnostic performance of PET/CT using gallium-68-labeled somatostatin receptor antagonists

Objective: Different SSTR2 antagonists have been developed. This study aims to evaluate the impact of different peptides and chelators on the diagnostic performance of SSTR2 antagonists in well-differentiated NETs.Methods: In this prospective study, participants were equally randomized into 2 arms: arm A, participants would undergo a whole-body^(68)Ga-NODAGA-LM3 PET/CT scan on the first day and^(68)Ga-DOTA-LM3 PET/CT scan on the second day;arm B, participants would undergo a whole-body^(68)Ga-NODAGA-LM3 PET/CT scan on the first day and^(68)Ga-NODAGA-JR11 PET/CT scan on the second day. Biodistribution in normal organs, lesion detection ability, and tumor uptakes were compared within each arm.Results: A total of 40 participants (age, 49.5 ± 13.4, 21 men), 20 in each arm, were recruited in the study. In arm A,^(68)Ga-DOTA-LM3 showed lower background. However, the lesion detection ability (overall lesion detected, 445 vs 548;P = .005) and the lesion uptake (overall lesions SUVmax, 19.8 ± 17.2 vs 35.3 ± 28.8;P < .001) was significantly lower than those of^(68)Ga-NODAGA-LM3. In arm B, both^(68)Ga-NODAGA-LM3 and^(68)Ga-NODAGA-JR11 showed similar biodistribution and lesion uptake (SUVmax, 28.5 ± 23.8 vs 25.0 ± 20.0;P < .001) despite minor differences. The lesion detection ability was the same between these 2 tracers (overall lesion detected, 503 vs 503).Conclusions: The diagnostic performance of SSTR2 antagonists was sensitive to chelators. Both^(68)Ga-NODAGA-LM3 and^(68)Ga-NODAGA-JR11 outperformed^(68)Ga-DOTA-LM3 with higher lesion uptake and detection ability, of which^(68)Ga-NODAGA-LM3 had marginally but significantly higher lesion uptake.

Initial chemotherapy option for pancreatic ductal adenocarcinoma in patients with adequate performance status

Pancreatic ductal adenocarcinoma(PDAC)is a highly progressive lethal malignancy,with chemotherapy being the primary treatment modality.This article provides a review of the initial chemotherapy options for PDAC patients with adequate performance status,comparing FOLFIRINOX(oxaliplatin,irinotecan,5-fluorouracil,and leucovorin)or modified FOLFIRINOX and gemcitabine plus nab-paclitaxel(GEM-NabP)regimens.The availability of limited evidence from randomized trials restricts a direct comparison between the 2 regimens.Based on our review,(m)FOLFIRINOX yields superior survival outcomes compared to GEM-NabP in metastatic PDAC.For locally advanced PDAC,either(m)FOLFIRINOX or GEM-NabP can be considered initial chemotherapy.In the neoadjuvant setting for borderline resectable PDAC,both regimens have demonstrated promising results in achieving feasible resection rates.However,mFOLFIRINOX remains the preferred choice for adjuvant chemotherapy.The selection of initial chemotherapy for PDAC depends on the disease stage,patients’performance status,and tumor molecular alterations.Further research and clinical trials are necessary to optimize treatment approaches for PDAC patients.

Laparoscopic radical distal pancreatectomy with portal venous tumor thrombectomy for the treatment of pancreatic acinar cell carcinoma after neoadjuvant chemotherapy

We have read the article“Current status and future prospect of surgical treatment for pancreatic cancer”,published in HepatoBiliary Surgery and Nutrition in 2020(1).This article mentions that in the past two decades,there has been significant development and progress in the surgical treatment of pancreatic cancer,significantly improving the tumor resection rate and reducing perioperative mortality and the incidence of severe complications.

Impact of antagonist peptides and chelators on the diagnostic performance of PET/CT using gallium-68 labeled somatostatin receptor antagonists

Objective:Different SSTR2 antagonists have been developed.This study aims to evaluate the impact of different peptides and chelators on the diagnostic performance of SSTR2 antagonists in well-differentiated NETs.Methods:In this prospective study,participants were equally randomized into two arms:Arm A,participants would undergo a whole-body 68Ga-NODAGA-LM3 PET/CT scan on the 1st day and 68Ga-DOTA-LM3 PET/CT scan on the 2nd day;Arm B,participants would undergo a whole-body 68Ga-NODAGA-LM3 PET/CT scan on the 1st day and 68Ga-NODAGA-JR11 PET/CT scan on the 2nd day.Biodistribution in normal organs,lesion detection ability,and tumor uptakes were compared within each Arm.Results:A total of 40 participants(age,49.5±13.4,21 men),20 in each arm,were recruited in the study.In Arm A,68Ga-DOTA-LM3 showed lower background.However,the lesion detection ability(overall lesion detected,445 versus 548,P=0.005)and the lesion uptake(overall lesions SUVmax,19.8±17.2 versus 35.3±28.8,P<0.001)was significantly lower than those of 68Ga-NODAGA-LM3.In Arm B,both 68Ga-NODAGA-LM3 and 68Ga-NODAGA-JR11 showed similar biodistribution and lesion uptake(SUVmax,28.5±23.8 versus 25.0±20.0,P<0.001)despite minor differences.The lesion detection ability was the same between these two tracers(overall lesion detected,503 versus 503).Conclusions:The diagnostic performance of SSTR2 antagonists was sensitive to chelators.Both 68Ga-NODAGA-LM3 and 68Ga-NODAGA-JR11 outperformed 68Ga-DOTA-LM3 with higher lesion uptake and detection ability,of which 68Ga-NODAGA-LM3 had marginally but significantly higher lesion uptake.