Tumori Journal Abstract Book - October 2020 - 55

C - Gastrointestinal (non-Colorectal) Cancers	
D'Aversa F.4, Perri V.5, Larghi A.5, Attili F.5, Inzani F.6, Alfieri S.2,
Tortora G.1, Salvatore L.1
1
Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico
Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore,
Roma; 2Chirurgia Digestiva, Comprehensive Cancer Center, Fondazione
Policlinico Universitario Agostino Gemelli-IRCCS. Università Cattolica del
Sacro Cuore, Roma; 3Dipartimento di Diagnostica per Immagini, Radioterapia
Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli"
IRCCS. Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma;
4
Gastroenterologia, Comprehensive Cancer Center, Fondazione Policlinico
Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore,
Roma; 5Endoscopia Digestiva Chirurgica, Comprehensive Cancer Center,
Fondazione Policlinico Universitario Agostino Gemelli -IRCCS, Università
Cattolica del Sacro Cuore, Roma; 6Anatomia patologica, Comprehensive
Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS.
Università Cattolica del Sacro Cuore, Roma

Background: The management of PD is very insidious,
due to the difficult differential diagnosis between benign
and malignant diseases, and, in case of pancreatic ductal
adenocarcinoma (PDCA), to the hard differentiation among
resectable/borderline PDCA susceptible to upfront surgery,
locally advanced PDCA susceptible to a neoadjuvant
approach and never resectable or metastatic PDCA in
which a palliative treatment is the only option. A correct PD
evaluation and the subsequent choice of the most appropriate treatment strategy need a MA, involving surgeons,
oncologists,
radiologists,
radiation
oncologists,
endoscopists, gastroenterologists and pathologists. We
investigate the impact of the multidisciplinary meeting
(MM) in the management of PD at our Institution.
Methods: We retrospectively evaluated all the cases discussed by surgeons at our MM. We collected data, both preand post-MM, regarding diagnosis (cyst vs pancreatitis vs
IPMN vs PDCA), and, in case of PDCA, tumor burden at
baseline (resectable vs border-line resectable vs locally
advanced vs metastatic disease) and disease response to
treatment (disease control vs progression). Primary endpoint was the overall rate of discrepancy in diagnosis and/or
PD evaluation between pre- and post-MM.
Results: From October 2018 to December 2019, a total of
139 cases were presented by surgeons. After MM, a total of
38 diagnosis and/or PD evaluation were modified, for an
overall discrepancy rate of 27%. In particular, of the 38 discordant cases, 9 (24%) were initial diagnosis, 24 (63%)
baseline tumor burden assessments and 5 (13%) were
PDCA response evaluations. Among the 24 cases of tumor
burden evaluations, treatment strategy changed in 17 out of
24 cases. More specifically, of the 19 cases, evaluated as
borderline/resectable before the MM, 15 were defined as
locally-advanced or metastatic disease after the MM; of the
5 cases, evaluated as not resectable before the MM, 2 were
considered border-line/resectable after the MM. Similarly,
out of 9 cases of discrepant initial diagnosis, 5 cases, considered as malignant disease before MM, were assessed as
benign after the MM.
Conclusions: Our analysis demonstrates a significant rate
of discrepancy in diagnosis and/or PD evaluation between

55
pre- and post-MM. Our results show that a MA allows a
considerable modification in PD diagnosis and evaluation,
maximizing the treatment strategy, in particular avoiding
unnecessary and detrimental pancreatic surgery.

C19
The impact of 2nd-line treatment
(tx) after 1st-line Gemcitabine
plus Nab-paclitaxel (GemNab) in
advanced pancreatic cancer (APC)
patients (pts)
Maratta M.G.1, Di Stefano B.2, Bensi M.2, Bagalà C.2, Spring A.2,
Chiaravalli M.2, Ribelli M.2, Tortora G.2, Salvatore L.2
1

Fondazione Policlinico A.Gemelli, Roma; 2Fondazione Policlinico A. Gemelli,
Roma

Background: Three main phase III randomized studies
investigated the role of 2nd-line tx in APC pts. The
PANCREOX study failed to demonstrate a survival advantage of mFOLFOX vs 5FU/LV. Conversely, the CONKO003 and NAPOLI-1 trials demonstrated a significant
survival improvement from the combination regimen, OFF
and 5FU+Nal-IRI, in comparison to 5FU/LV alone. Final
OS analysis from NAPOLI-1 demonstrated an association
of specific characteristics (ECOG PS, age, Ca 19.9 baseline
level, neutrophil-to-lymphocyte ratio, no liver metastases
(m)) with OS > 1 year. The main limit of all these studies
was due to the period they were carried out: no pts received
1st-line GemNab. We retrospectively analyzed a homogeneous population of APC treated with 1st-line GemNab at our
Institution investigating the impact of 2nd-line tx.
Methods: APC pts receiving a 2nd-line tx after 1st-line
GemNab were included in the analysis. The following
variables were collected: gender; age (> vs = 55 years
and = vs < 70 years ); baseline ECOG PS (0-1 vs 2-3); Ca
19.9 baseline level (= vs < 200); anamnesis of diabetes;
site of primary tumor (head/uncinate process vs body/tail);
number of m sites (1 vs >1); m sites (liver, peritoneum,
lung, nodes); RECIST response and ETS during 1-line
GemNab. Univariate and multivariate analyses for PFS
and OS were performed.
Results: Out of 167 APC pts progressed to 1st-line GemNab,
93 (56%) pts received a 2nd-line tx, specifically 58 received
an oxa-based regimen, 11 FOLFIRINOX, 8 FOLFIRI and
16 other tx. Median 2nd-line PFS and OS were 3.3 and 5.6
months respectively. Out of 87 pts evaluable for response, 7
achieved a partial response and 27 a stable disease, with a
RR and a disease control rate (DCR) of 8% and 39% respectively. Pts with baseline ECOG PS 0-1 had a significant better outcome in comparison to with PS 3-4 (PFS 4.2 vs 1.2
months, p < 0.0001; OS 7.2 vs 2.6 months, p = 0.0001).
This significant association with survival parameters and
ECOG PS was confirmed at the multivariate analysis.



Tumori Journal Abstract Book - October 2020

Table of Contents for the Digital Edition of Tumori Journal Abstract Book - October 2020

Contents
Tumori Journal Abstract Book - October 2020 - Cover1
Tumori Journal Abstract Book - October 2020 - Cover2
Tumori Journal Abstract Book - October 2020 - I
Tumori Journal Abstract Book - October 2020 - II
Tumori Journal Abstract Book - October 2020 - Contents
Tumori Journal Abstract Book - October 2020 - IV
Tumori Journal Abstract Book - October 2020 - V
Tumori Journal Abstract Book - October 2020 - 1
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Tumori Journal Abstract Book - October 2020 - Cover3
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