Original Article(s)

• Efficacy and Tolerability of Neoadjuvant Chemotherapy with Gemcitabine and Nab-Paclitaxel in Patients with Borderline Resectable and Locally Advanced Pancreatic Adenocarcinoma: A Retrospective Analysis

  Seyed Amir Hossein Emami , Ahmad Narimani , Seyed Reza Safaee-Nodehi , Hossein Ranjbar , Yasaman Gholinezhed , Nahal Ghane , Ahmad Khajeh-Mehrizi

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  Abstract

  Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, and the role of neoadjuvant therapy has expanded in borderline resectable and locally advanced disease. Gemcitabine plus nab-paclitaxel (GnP) is an established systemic regimen, but real-world data in this setting remain limited in Iran.

  Material and Methods: We retrospectively reviewed patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who received neoadjuvant GnP at two oncology centers between March 2021 and March 2024. Baseline characteristics, laboratory parameters, treatment tolerance, radiographic response, surgical outcomes, and survival were extracted from medical records. Response was assessed by RECIST criteria, and treatment decisions were made by multidisciplinary review.

  Results: Seventeen patients were included. The median age was 61 years, and 58.8% were male. Partial response was achieved in 41.2%, stable disease in 52.9%, and progression in 5.9%, yielding a disease control rate of 94.1%. Eleven patients underwent resection, and 9 of 11 resected patients achieved R0 margins. All patients completed the planned two cycles of neoadjuvant treatment without permanent discontinuation or treatment-related mortality. The median follow-up was 23 months, median disease-free survival was 14 months, and median overall survival was 23 months.

  Conclusion: This small, retrospective analysis suggests that neoadjuvant GnP is feasible in the Iranian clinical setting, with an acceptable safety profile and encouraging preliminary outcomes among selected patients with BRPC and LAPC. However, given the limited sample size and single-arm design, these findings are hypothesis-generating only. Large-scale prospective studies with control arms are required to establish the efficacy of this approach