Nab-P, an albumin bound formulation of paclitaxel particles, appears to have advantages over the soluble formulation, with less toxicity and increased local concentration targeting stromal-rich tumors. In a mouse model, it has been shown to decrease levels of cytidine deaminase, the primary gemcitabine catabolic enzyme, through the generation of reactive oxygen species, thereby increasing sensitivity to GEM (5). This suggests potential Inhibitors,research,lifescience,medical benefit from the combination of both agents. A phase I/II trial exploring GEM plus nab-P in metastatic pancreatic adenocarcinoma showed substantial antitumor activity with tolerable side effects. At a maximum tolerated dose

of 1,000 mg/m2 of GEM and 125 mg/m2 of nab-P administered once a week for 3 weeks every 28 days, there was a 48% response rate and a 48% 1-year survival (6). At this time, no phase III studies evaluating this combination in pancreatic cancer have been published. A single center retrospective review evaluated 13 patients with LAPC undergoing neoadjuvant Inhibitors,research,lifescience,medical chemotherapy with GEM/nab-P Inhibitors,research,lifescience,medical plus or minus chemoradiation. The regimen was given as cycles of GEM 1,000 mg/m2 and nab-P 100 mg/m2 weekly, 3 weeks on and one week off, with Enzastaurin order appropriate modifications. 77% of patients received chemoradiation and 38% underwent resection. Overall survival was 85% at six months and 77% at twelve months. Progression-free survival at six months was 100% and 88% in the resected

and non-resected groups, respectively Inhibitors,research,lifescience,medical (7). The timing for surgical exploration after neo-adjuvant therapy remains debatable. Some centers reserve surgical exploration only for patients with evidence of tumor downsizing. Other centers consider exploration for patients with radiographic stable disease and normalization of CA19-9

(8). The decision whether to offer patients the possibility of surgery and cure and avoid prolonged courses of neoadjuvant treatments requires a multidisciplinary approach and the development of clearer guidelines. Other investigators observations and well-designed Inhibitors,research,lifescience,medical phase II trials using this combination with or without chemoradiation will go a long way in Bumetanide defining its efficacy in LAPC and its possible role as neoadjuvant or definitive therapy in locally advanced disease. Acknowledgements Disclosure: The authors declare no conflict of interest.
Within the DPAM group, the 5-year survival of patients who were CA 19-9 positive versus those with normal values were 58% and 90% respectively (P<0.001). Other variables found to negatively impact on OS in univariate analyses were completeness of cytoreduction (CC) score 2/3 (P<0.001), peritoneal cancer index (PCI) >25 (P<0.001) and male gender (P=0.017). In the Cox regression model, only CA 19-9 positivity was found to be an independent prognostic factor for OS (P=0.034). In addition to marker positivity, the absolute level of CA 19-9 was also prognostically significant.