Best Practices for Delivering Neoadjuvant Therapy in Pancreatic Ductal Adenocarcinoma
Authors: Cloyd Jordan M. , Sarna Angela , Arango Matthew J. , Bates Susan E. , Bhutani Manoop S. , Bloomston Mark , Chung Vincent , Dotan Efrat , Ferrone Cristina R. , Gambino Patricia F. , Goenka Ajit H. , Goodman Karyn A. , Hall William A. , He Jin , Hogg Melissa E. , Jayaraman Shiva , Kambadakone Avinash , Katz Matthew H. G. , Khorana Alok A. , Ko Andrew H. , Koay Eugene J. , Kooby David A. , Krishna Somashekar G. , Larsson Liliana K. , Lee Richard T. , Maitra Anirban , Massarweh Nader N. , Mikhail Sameh , Muzaffar Mahvish , O’Reilly Eileen M. , Palta Manisha , Petzel Maria Q. B. , Philip Philip A. , Reyngold Marsha , Santa Mina Daniel , Sohal Davendra P. S. , Sundaresan Tilak K. , Tsai Susan , Turner Kea L. , Vreeland Timothy J. , Walston Steve , Washington M. Kay , Williams Terence M. , Wo Jennifer Y. , Snyder Rebecca A. 
Published: December 2024

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.