The PREP-02/JSAP05 trial showed that giving chemotherapy before surgery can improve survival for patients with Pancreatic Ductal Adenocarcinoma, the most common type of pancreatic cancer.
In this study, researchers compared two treatment approaches. One group of patients had immediate surgery, while the other received chemotherapy with Gemcitabine and S-1 before surgery. After surgery, both groups were planned to receive additional treatment with S-1.
The results showed clear benefits for patients who received chemotherapy first. Median overall survival was 37.0 months for patients treated with pre-surgery chemotherapy, compared with 26.6 months for those who had surgery first. The three-year survival rate was also higher in the chemotherapy-first group (50.2% vs 36.6%). Patients in the neoadjuvant group also had longer relapse-free survival (14.3 months vs 11.3 months).
The treatment also reduced the risk of cancer spreading to the liver. Liver recurrence occurred in 30% of patients who received chemotherapy before surgery, compared with 47.9% in the surgery-first group. In addition, fewer patients in the chemotherapy group had cancer spread to lymph nodes.
Researchers found that giving chemotherapy before surgery did not increase surgical complications or death rates. It also allowed doctors to identify patients whose cancer progressed during treatment, helping them avoid major surgery that would likely not have been beneficial.
Overall, the study suggests that chemotherapy with gemcitabine and S-1 before surgery may become a new standard treatment approach for patients with resectable pancreatic cancer because it improves survival without adding surgical risk.