In ampullary adenocarcinoma, adjuvant 5-FU is tied to better outcomes than gemcitabine

  • Al Abbas AI & al.
  • J Surg Oncol
  • 15 Dec 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • 5-FU-based adjuvant therapy is associated with better survival than gemcitabine-based regimens in all immunohistochemical subtypes of ampullary adenocarcinoma.

Why this matters

  • The findings suggest 5-FU may be a potential first-line therapy in advanced disease, with gemcitabine secondary if 5-FU is not well tolerated.

Study design

  • Retrospective analysis (n=121; 32% intestinal, 48% pancreatobiliary, 20% ambiguous).
  • Funding: None disclosed.

Key results

  • 39% of patients received adjuvant chemotherapy: 27% gemcitabine-based, 12% 5-FU-based.
  • Median survival:
    • Intestinal, 45.6 (95% CI, 21.4-104.3) months.
    • Pancreatobiliary, 31.3 (95% CI, 23.9-40.4) months.
    • Ambiguous, 46.9 (95% CI, 23.5-87.4) months.
  • Adjuvant chemotherapy was associated with longer survival (45.6 vs 32.1 months; P=.032).
  • Adjuvant chemotherapy with 5-FU was associated with longer survival (87.4 [95% CI, 40.4 to not reached] months) than gemcitabine (38 [95% CI, 23.57 to not reached] months) and no treatment (32.1 [95% CI, 23.5-46.9] months).
  • Multivariable analysis showed that treatment with 5-FU was an independent predictor of better survival (HR, 0.24; P=.031).
  • Receipt of gemcitabine-based adjuvant chemotherapy was not associated with survival.
  • Adjuvant chemotherapy was associated with better survival in stage IIB and III diseases (38.6 vs 21.43 months; P<.01 but not in early-stage disease.>

Limitations

  • Retrospective analysis.