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Pancreatic Neoplasms: HELP
Articles by Davendra P. S. Sohal
Based on 14 articles published since 2008

Between 2008 and 2019, Davendra Sohal wrote the following 14 articles about Pancreatic Neoplasms.
+ Citations + Abstracts
1 Guideline Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Summary. 2017

Sohal, Davendra P S / Mangu, Pamela B / Laheru, Daniel. ·Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD. ·J Oncol Pract · Pubmed #28399388.

ABSTRACT: -- No abstract --

2 Guideline Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. 2016

Sohal, Davendra P S / Mangu, Pamela B / Khorana, Alok A / Shah, Manish A / Philip, Philip A / O'Reilly, Eileen M / Uronis, Hope E / Ramanathan, Ramesh K / Crane, Christopher H / Engebretson, Anitra / Ruggiero, Joseph T / Copur, Mehmet S / Lau, Michelle / Urba, Susan / Laheru, Daniel. ·Davendra P.S. Sohal and Alok A. Khorana, Cleveland Clinic, Cleveland, OH · Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA · Manish A. Shah, The Weill Cornell Medical Center · Philip A. Philip, Karmanos Cancer Institute, Detroit · Susan Urba, University of Michigan Cancer Center, Ann Arbor, MI · Eileen M. O'Reilly, Memorial Sloan Kettering Cancer Center · Joseph T. Ruggiero, Weill Cornell Medical College, New York, NY · Hope E. Uronis, Duke University, Durham, NC · Ramesh K. Ramanathan, Mayo Clinic, Scottsdale · Michelle Lau, Community Hospital Based Cancer Center, Tempe, AZ · Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX · Anitra Engebretson, Patient Representative, Portland, OR · Mehmet S. Copur, St Francis Medical Center, Grand Island, NE · and Daniel Laheru, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD. ·J Clin Oncol · Pubmed #27247222.

ABSTRACT: PURPOSE: To provide evidence-based recommendations to oncologists and others for the treatment of patients with metastatic pancreatic cancer. METHODS: American Society of Clinical Oncology convened an Expert Panel of medical oncology, radiation oncology, surgical oncology, gastroenterology, palliative care, and advocacy experts to conduct a systematic review of the literature from April 2004 to June 2015. Outcomes were overall survival, disease-free survival, progression-free survival, and adverse events. RESULTS: Twenty-four randomized controlled trials met the systematic review criteria. RECOMMENDATIONS: A multiphase computed tomography scan of the chest, abdomen, and pelvis should be performed. Baseline performance status and comorbidity profile should be evaluated. Goals of care, patient preferences, treatment response, psychological status, support systems, and symptom burden should guide decisions for treatments. A palliative care referral should occur at first visit. FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin; favorable comorbidity profile) or gemcitabine plus nanoparticle albumin-bound (NAB) -paclitaxel (adequate comorbidity profile) should be offered to patients with Eastern Cooperative Oncology Group performance status (ECOG PS) 0 to 1 based on patient preference and support system available. Gemcitabine alone is recommended for patients with ECOG PS 2 or with a comorbidity profile that precludes other regimens; the addition of capecitabine or erlotinib may be offered. Patients with an ECOG PS ≥ 3 and poorly controlled comorbid conditions should be offered cancer-directed therapy only on a case-by-case basis; supportive care should be emphasized. For second-line therapy, gemcitabine plus NAB-paclitaxel should be offered to patients with first-line treatment with FOLFIRINOX, an ECOG PS 0 to 1, and a favorable comorbidity profile; fluorouracil plus oxaliplatin, irinotecan, or nanoliposomal irinotecan should be offered to patients with first-line treatment with gemcitabine plus NAB-paclitaxel, ECOG PS 0 to 1, and favorable comorbidity profile, and gemcitabine or fluorouracil should be offered to patients with either an ECOG PS 2 or a comorbidity profile that precludes other regimens. Additional information is available at www.asco.org/guidelines/MetPC and www.asco.org/guidelineswiki.

3 Review Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients. 2017

Dhir, Mashaal / Malhotra, Gautam K / Sohal, Davendra P S / Hein, Nicholas A / Smith, Lynette M / O'Reilly, Eileen M / Bahary, Nathan / Are, Chandrakanth. ·Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, 13210, USA. · Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 98198, USA. · Division of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 44195, USA. · Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA. · David M. Rubenstein Center for Pancreatic Cancer, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. · Department of Medicine, Division of Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA. · Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, NE, 98198, USA. care@unmc.edu. · Department of Surgery/Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, 68198, USA. care@unmc.edu. ·World J Surg Oncol · Pubmed #29017581.

ABSTRACT: BACKGROUND: Recent years have seen standardization of the anatomic definitions of pancreatic adenocarcinoma, and increasing utilization of neoadjuvant therapy (NAT). The aim of the current review was to summarize the evidence for NAT in pancreatic adenocarcinoma since 2009, when consensus criteria for resectable (R), borderline resectable (BR), and locally advanced (LA) disease were endorsed. METHODS: PubMed search was undertaken along with extensive backward search of the references of published articles to identify studies utilizing NAT for pancreatic adenocarcinoma. Abstracts from ASCO-GI 2014 and 2015 were also searched. RESULTS: A total of 96 studies including 5520 patients were included in the final quantitative synthesis. Pooled estimates revealed 36% grade ≥ 3 toxicities, 5% biliary complications, 21% hospitalization rate and low mortality (0%, range 0-16%) during NAT. The majority of patients (59%) had stable disease. On an intention-to-treat basis, R0-resection rates varied from 63% among R patients to 23% among LA patients. R0 rates were > 80% among all patients who were resected after NAT. Among R and BR patients who underwent resection after NAT, median OS was 30 and 27.4 months, respectively. CONCLUSIONS: The current study summarizes the recent literature for NAT in pancreatic adenocarcinoma and demonstrates improving outcomes after NAT compared to those historically associated with a surgery-first approach for pancreatic adenocarcinoma.

4 Review Pancreatic Adenocarcinoma: Improving Prevention and Survivorship. 2017

Sohal, Davendra P S / Willingham, Field F / Falconi, Massimo / Raphael, Kara L / Crippa, Stefano. ·From the Cleveland Clinic, Cleveland, OH; Emory University School of Medicine, Atlanta, GA; Division of Pancreatic Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy. ·Am Soc Clin Oncol Educ Book · Pubmed #28561672.

ABSTRACT: Pancreatic cancer is a growing problem in oncology, given slowly rising incidence and continued suboptimal outcomes. A concerted effort to reverse this tide will require prevention, early diagnosis, and improved systemic therapy for curable disease. We focus on these aspects in detail in this study. Hereditary pancreatic cancer is an underappreciated area. With the growing use of genomics (both somatic and germline) in cancer care, there is increasing recognition of hereditary pancreatic cancer cases: around 10% of all pancreatic cancer may be related to familial syndromes, such as familial atypical multiple mole and melanoma (FAMMM) syndrome, hereditary breast and ovarian cancer, Lynch syndrome, and Peutz-Jeghers syndrome. Screening and surveillance guidelines by various expert groups are discussed. Management of resectable pancreatic cancer is evolving; the use of multiagent systemic therapies, in the adjuvant and neoadjuvant settings, is discussed. Current and emerging data, along with ongoing clinical trials addressing important questions in this area, are described. Surveillance recommendations based on latest ASCO guidelines are also discussed. Finally, the multimodality management of borderline resectable pancreatic cancer is discussed. The various clinicoanatomic definitions of this entity, followed by consensus definitions, are described. Then, we focus on current opinions and practices around neoadjuvant therapy, discussing chemotherapy and radiation aspects, and the role of surgical resection.

5 Review Pancreatic adenocarcinoma: treating a systemic disease with systemic therapy. 2014

Sohal, Davendra P S / Walsh, R Matthew / Ramanathan, Ramesh K / Khorana, Alok A. ·Affiliations of authors: Taussig Cancer Institute and Lerner College of Medicine (DPSS, AAK) and Digestive Disease Institute and Lerner College of Medicine (RMW), Cleveland Clinic, Cleveland, OH · Virgina G. Piper Cancer Center, Translational Genomics Research Institute, Scottsdale, AZ (RKR). ·J Natl Cancer Inst · Pubmed #24563516.

ABSTRACT: Pancreatic adenocarcinoma, even when resectable, remains highly lethal. Although surgical outcomes have improved considerably, median overall survival after surgery and adjuvant therapy such as single-agent gemcitabine remains less than 2 years. We discuss preclinical and clinical data supporting the contention that even early-stage pancreatic cancer is a systemic disease. Autopsy series reveal that 70% to 85% of patients die of systemic recurrence, rather than local disease, after pancreatic cancer resection. Preclinical studies using genomics and mouse models reveal evidence of metastatic spread even before histopathologic evidence of a pancreatic tumor. Analogous to breast cancer, we propose that the Halstedian approach of treating pancreatic cancer as a local, surgical problem should be replaced by Fisher's alternative hypothesis of cancer as a systemic disease. Newer multiagent chemotherapy regimens have shown meaningful response rates and improvement in overall survival in the metastatic setting and, for the first time, offer investigators an opportunity to use effective systemic therapy. We emphasize that a surgery-first approach is not resonant with our current understanding of pancreatic adenocarcinoma biology and that an upfront systemic approach for even resectable pancreatic cancer warrants testing in clinical trials.

6 Clinical Trial Toxicity study of gemcitabine, oxaliplatin, and bevacizumab, followed by 5-fluorouracil, oxaliplatin, bevacizumab, and radiotherapy, in patients with locally advanced pancreatic cancer. 2013

Sohal, Davendra P S / Metz, James M / Sun, Weijing / Giantonio, Bruce J / Plastaras, John P / Ginsberg, Gregory / Kochman, Michael L / Teitelbaum, Ursina R / Harlacker, Kathleen / Heitjan, Daniel F / Feldman, Michael D / Drebin, Jeffrey A / O'Dwyer, Peter J. ·Cleveland Clinic, Taussig Cancer Institute, 9500 Euclid Avenue, R35, Cleveland, OH 44195, USA. sohald@ccf.org ·Cancer Chemother Pharmacol · Pubmed #23532207.

ABSTRACT: PURPOSE: Platinum compounds or bevacizumab, in combination with gemcitabine, achieved good response rates in early studies in advanced pancreatic cancer. This prompted an evaluation of an aggressive approach to allow better local control and resectability in locally advanced disease. METHODS: We piloted a combination of gemcitabine/oxaliplatin/bevacizumab Q2w for four cycles, followed by oxaliplatin and bevacizumab added to infusional 5-FU and radiotherapy, in patients with locally advanced pancreatic cancer. RESULTS: Nineteen patients were treated, of whom 17 completed the protocol-specified treatment. Median age was 60 years. Fifteen had unresectable, and four had borderline resectable disease. Toxicity of chemotherapy was moderate: grade III neutropenia (5) and grade I/II nausea, vomiting, fatigue, and neuropathy. During chemoradiation, major grade III toxicities were nausea and vomiting (3 each). One patient had intractable pain early on, necessitating treatment cessation. Response rate for 18 evaluable patients was 11 % (by RECIST); five patients (4 inoperable, 1 borderline, 26 %) went on to have surgery. One-year overall survival was 58 % and progression-free survival was 37 %. CONCLUSIONS: This combination, associated with higher response rates in metastatic disease, had a lower than expected response rate in primary tumors. Although tolerable, our approach failed to affect clinical outcomes meaningfully.

7 Article Do patients with pancreatic body or tail cancer benefit from adjuvant therapy?A cohort study. 2018

Sohal, Davendra P S / Tullio, Katherine / Khorana, Alok A. ·Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, R35, Cleveland, OH 44195, United States. Electronic address: sohald@ccf.org. · Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, R35, Cleveland, OH 44195, United States. ·Surg Oncol · Pubmed #29937178.

ABSTRACT: INTRODUCTION: Evidence supporting adjuvant therapy for resected pancreatic cancer is limited primarily to head tumors. We analyzed data from the National Cancer Database (NCDB) to evaluate the relationship of tumor site with benefit from adjunctive (adjuvant, neoadjuvant, perioperative) therapy (Rx). METHODS: All NCDB patients with clinical stage I and II pancreatic cancer, diagnosed from 2003 to 2013, who underwent surgical resection and had data on site of primary were included. Overall survival (OS) analyses with hazard ratios (HR), 95% confidence intervals (CI), and two-sided p-values are presented. RESULTS: A total of 27,930 patients met inclusion criteria; median age 66 years, 51% males, 86% white. Primary site was coded as head (74.4%), body (9.3%), or tail (16.3%). Pathologic stage was predominantly stage II (77%); 81% had negative margins. Perioperative Rx was used in 4%, neoadjuvant in 8%, adjuvant in 48%. Median OS for the cohort was 24 months; for head, body and tail tumors, it was 21.6, 34.5, and 42.5 months, respectively. In univariable analyses, adjunctive Rx was associated with improved OS in head tumors (HR, any Rx vs. no Rx: 0.87; 95% CI 0.84-0.91; p < 0.0001) but not in body (1.82; 1.59-2.08; <0.0001) and tail (2.28; 2.05-2.53; <0.0001) tumors; multivariable models including statistically significant predictors (Charlson-Deyo comorbidity score, tumor grade and stage, positive resection margin) confirmed these results. CONCLUSIONS: Our study suggests that the benefit of adjunctive Rx is restricted to pancreatic head tumors; body and tail tumors have a much better prognosis. These results warrant further evaluation in prospective studies.

8 Article Point: Weighing the Risks and Benefits of Neoadjuvant Therapy in Resectable Pancreatic Cancer. Early, Aggressive Neoadjuvant Therapy Is Appropriate in Selected Patients. 2018

Sohal, Davendra P S. · ·Oncology (Williston Park) · Pubmed #29447420.

ABSTRACT: -- No abstract --

9 Article Adjuvant and neoadjuvant therapy for resectable pancreatic adenocarcinoma. 2017

Sohal, Davendra P S. ·Cleveland Clinic Taussig Cancer Institute, Cleveland, USA. sohald@ccf.org. ·Chin Clin Oncol · Pubmed #28705003.

ABSTRACT: Resectable pancreatic adenocarcinoma presents the opportunity for cure of this highly lethal disease by allowing complete surgical removal. However, cure rates remain low. Adjuvant therapy following surgical resection is the standard of care. Most data support the use of gemcitabine or 5-fluorouracil in the adjuvant setting, and emerging data indicate gemcitabine plus capecitabine may improve outcomes. Use of adjuvant radiation remains controversial. Ongoing clinical studies will help better define the role of multi-agent regimens as well as radiation in the adjuvant setting. Neoadjuvant therapy holds the promise of allowing early control of systemic disease with increased delivery of aggressive chemotherapy regimens. Prior studies are mostly small, single-institution trials, making it difficult to draw conclusions. Ongoing trials across the world are systematically testing this approach and may lead to a new therapeutic approach to resectable pancreatic cancer.

10 Article Prospective Clinical Study of Precision Oncology in Solid Tumors. 2015

Sohal, Davendra P S / Rini, Brian I / Khorana, Alok A / Dreicer, Robert / Abraham, Jame / Procop, Gary W / Saunthararajah, Yogen / Pennell, Nathan A / Stevenson, James P / Pelley, Robert / Estfan, Bassam / Shepard, Dale / Funchain, Pauline / Elson, Paul / Adelstein, David J / Bolwell, Brian J. ·Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH (DPSS, BIR, AAK, RD, JA, GWP, YS, NAP, JPS, RP, BE, DS, PF, PE, DJA, BJB) · University of Virginia School of Medicine, Charlottesville, VA (RD). ·J Natl Cancer Inst · Pubmed #26553780.

ABSTRACT: Systematic studies evaluating clinical benefit of tumor genomic profiling are lacking. We conducted a prospective study in 250 patients with select solid tumors at the Cleveland Clinic. Eligibility required histopathologic diagnosis, age of 18 years or older, Eastern Cooperative Oncology Group performance status 0-2, and written informed consent. Tumors were sequenced using FoundationOne (Cambridge, MA). Results were reviewed at the Cleveland Clinic Genomics Tumor Board. Outcomes included feasibility and clinical impact. Colorectal (25%), breast (18%), lung (13%), and pancreatobiliary (13%) cancers were the most common diagnoses. Median time from consent to result was 25 days (range = 3-140). Of 223 evaluable samples, 49% (n = 109) of patients were recommended a specific therapy, but only 11% (n = 24) received such therapy: 12 on clinical trials, nine off-label, three on-label. Lack of clinical trial access (n = 49) and clinical deterioration (n = 29) were the most common reasons for nonrecommendation/nonreceipt of genomics-driven therapy.

11 Article Predicting early mortality in resectable pancreatic adenocarcinoma: A cohort study. 2015

Sohal, Davendra P S / Shrotriya, Shiva / Glass, Kate Tullio / Pelley, Robert J / McNamara, Michael J / Estfan, Bassam / Shapiro, Marc / Wey, Jane / Chalikonda, Sricharan / Morris-Stiff, Gareth / Walsh, R Matthew / Khorana, Alok A. ·Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. · Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio. ·Cancer · Pubmed #25676016.

ABSTRACT: BACKGROUND: Survival after surgical resection for pancreatic cancer remains poor. A subgroup of patients die early (<6 months), and understanding factors associated with early mortality may help to identify high-risk patients. The Khorana score has been shown to be associated with early mortality for patients with solid tumors. In the current study, the authors evaluated the role of this score and other prognostic variables in this setting. METHODS: The current study was a cohort study of patients who underwent surgical resection for pancreatic cancer from January 2006 through June 2013. Baseline (diagnosis ±30 days) parameters were used to define patients as high risk (Khorana score ≥3). Statistically significant univariable associations and a priori prognostic variables were tested in multivariable models; adjusted hazard ratios (HR) were calculated. RESULTS: The study population comprised 334 patients. The median age was 67 years, 50% of the study population was female, and 86% of the patients were white. The pancreatic head was the primary tumor site for 73% of patients; 67% of tumors were T3 and 63% were N1. The median Khorana score was 2; 152 patients (47%) were determined to be high risk. Adjunctive treatment included chemotherapy (70%) and radiotherapy (40%). The postoperative (30-day) mortality rate was 0.9%. The 6-month mortality rate for the entire cohort was 9.4%, with significantly higher rates observed for high-risk patients (13.4% vs 5.6%; P = .02). On multivariable analyses (examining a total of 326 patients), the Khorana score (HR for high risk, 2.31; P = .039) and elevated blood urea nitrogen (HR, 4.34; P<.001) were associated with early mortality. CONCLUSIONS: Patients at high risk of early mortality after surgical resection of pancreatic adenocarcinoma can be identified using simple baseline clinical and laboratory parameters. Future studies should address preoperative interventions in these patients at high risk of early mortality.

12 Article Resection status, age and nodal involvement determine survival among patients receiving adjuvant chemoradiotherapy in pancreatic adenocarcinoma. 2011

Moghanaki, Drew / Mick, Rosemarie / Furth, Emma Elizabeth / Sohal, Davendra / Salmon, Patricia M / Behbahani, Ali / Morgans, Alicia K / Miller, Seth M / Giantonio, Bruce J / Whittington, Richard W / Haller, Daniel G / Rosato, Ernest F / Plastaras, John P. ·Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA. ·JOP · Pubmed #21904068.

ABSTRACT: CONTEXT: Pancreas cancer can potentially be cured by resection, but the role of adjuvant chemotherapy and/or chemoradiation has been controversial. OBJECTIVES: To better define clinicopathological factors that may serve as predictive and/or prognostic variables. PATIENTS: Between 1984 and 2006, we retrospectively analyzed 91 patients with pancreas cancer treated with pancreaticoduodenectomy or total pancreatectomy followed by adjuvant 5-fluorouracil-based chemoradiation at the University of Pennsylvania. Final pathological coding including margin status was confirmed by a pathologist. INTERVENTIONS: Patients were treated with 48.6 to 63.0 Gy, and 96.7% completed their prescribed radiation dose. MAIN OUTCOME MEASURES: The prognostic significance of demographic factors, stage, year of surgery, tumor location, grade, resection status, and number of positive lymph nodes on overall survival were examined. RESULTS: With a median follow-up of 6.5 years, the overall median survival was 2.3 years (95% CI 1.5-3.2 years), and the 5-year overall survival was 28.9%. In multivariate analysis, completeness of resection (P<0.001), fewer number of positive lymph nodes (0 vs. 1-2 vs. 3 or more) (P=0.004), and age less than, or equal to, 60 years (P=0.006) were all independently associated with improved overall survival. The overall survival reported in this study compares favorably with the results of other single-institution studies and with the RTOG 97-04 trial. CONCLUSIONS: Adjuvant 5-FU-based chemoradiation following radical pancreatectomy can be delivered safely and results in comparatively good overall survival. The results of this analysis underscore the importance of resection status, number of involved lymph nodes and patient age as prognostic characteristics. These factors may be considered stratification variables for future post-pancreatectomy adjuvant therapy trials.

13 Minor Adjuvant Treatment in Potentially Curable Pancreatic Cancer: Need to Include Tumor Location in the Equation? 2018

Mukhija, Dhruvika / Sohal, Davendra P S / Khorana, Alok A. ·Department of Internal Medicine Taussig Cancer Center Cleveland Clinic Cleveland, OH Department of Hematology and Oncology Taussig Cancer Center Cleveland Clinic Cleveland, OH khorana@ccf.org. ·Pancreas · Pubmed #30113430.

ABSTRACT: -- No abstract --

14 Minor Reply to A. Wang-Gillam et al. 2017

Sohal, Davendra P S / Mangu, Pamela B / Laheru, Daniel / Khorana, Alok A. ·Davendra P.S. Sohal, Cleveland Clinic, Cleveland, OH · Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA · Daniel Laheru, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD · and Alok A. Khorana, Cleveland Clinic, Cleveland, OH. ·J Clin Oncol · Pubmed #27918714.

ABSTRACT: -- No abstract --