Faculty Collaboration Database

Best Practices for Delivering Neoadjuvant Therapy in Pancreatic Ductal Adenocarcinoma. JAMA Surg 2025 Feb 01;160(2):172-180

Date

12/04/2024

Pubmed ID

39630427

Pubmed Central ID

PMC11618571

DOI

10.1001/jamasurg.2024.5191

Scopus ID

2-s2.0-85218493135 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

IMPORTANCE: Neoadjuvant therapy (NT) is an increasingly used treatment strategy for patients with localized pancreatic ductal adenocarcinoma (PDAC). Little research has been conducted on cancer care delivery during NT, and the standards for optimal delivery of NT have not been defined.

OBJECTIVE: To develop consensus best practices for delivering NT to patients with localized PDAC.

DESIGN, SETTING, AND PARTICIPANTS: This study used a modified Delphi approach consisting of 2 rounds of voting, and a series of virtual conferences (from October to December 2023) to reach expert consensus on candidate best practice statements generated from a systematic review of the literature and expert opinion. An interdisciplinary panel was formed including 47 North American experts from surgical, medical, and radiation oncology, radiology, pathology, gastroenterology, integrative oncology, anesthesia, pharmacy, nursing, cancer care delivery research, and nutrition as well as patient and caregiver stakeholders.

MAIN OUTCOME AND MEASURES: Statements that reached 75% agreement or greater were included in final consensus statements.

RESULTS: Of the 47 participating panel members, 27 (57.64%) were male, and the mean (SD) age was 47.6 (8.2) years. Physicians reported completing training a mean (SD) 14.6 (8.6) years prior and seeing a mean (SD) 110.6 (38.4) patients with PDAC annually; 35 (77.7%) were in academic practice. Final consensus was reached on 82 best practices for delivering NT. Of these, 38 statements focused on pre-NT practices, including diagnosis and staging (n = 15), evaluation and optimization (n = 20), and decision-making (n = 3); 29 statements defined best practices during NT, including initiation (n = 3), delivery of therapy (n = 8), restaging practices (n = 12), and management of complications during NT (n = 6); and 15 best practices were identified to guide treatment post-NT, focusing on surgery (n = 7), pathology (n = 4), and follow-up (n = 3).

CONCLUSIONS: Using a modified Delphi consensus technique, best practice guidelines were developed focusing on the optimal standards for delivering NT to patients with localized PDAC. Given the prognostic importance of completing multimodality therapy, efforts to standardize and optimize the delivery of NT represent an immediate opportunity to decrease care variation and improve outcomes for patients with PDAC. Future research should focus on validating and implementing best practice standards into clinical practice.

Author List

Cloyd JM, Sarna A, Arango MJ, Bates SE, Bhutani MS, Bloomston M, Chung V, Dotan E, Ferrone CR, Gambino PF, Goenka AH, Goodman KA, Hall WA, He J, Hogg ME, Jayaraman S, Kambadakone A, Katz MHG, Khorana AA, Ko AH, Koay EJ, Kooby DA, Krishna SG, Larsson LK, Lee RT, Maitra A, Massarweh NN, Mikhail S, Muzaffar M, O'Reilly EM, Palta M, Petzel MQB, Philip PA, Reyngold M, Santa Mina D, Sohal DPS, Sundaresan TK, Tsai S, Turner KL, Vreeland TJ, Walston S, Washington MK, Williams TM, Wo JY, Snyder RA

Author

William Adrian Hall MD Chair, Professor in the Radiation Oncology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Carcinoma, Pancreatic Ductal
Delphi Technique
Female
Humans
Male
Middle Aged
Neoadjuvant Therapy
Pancreatic Neoplasms