Irreversible electroporation shows promise in locally advanced pancreatic cancer

  • Ruarus AH & al.
  • Radiology
  • 5 Nov 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Irreversible electroporation (IRE) appeared to extend survival over chemotherapy in locally advanced pancreatic cancer, but the procedure is risky with a high complication rate.

Why this matters

  • Previous studies confirmed the safety profile of IRE and showed some evidence of efficacy, but they were retrospective.

Study design

  • Multicenter, single-arm, phase 2 trial (PANFIRE, n=50).
  • Funding: National Foundation Against Cancer, Foundation for Image-Guided Cancer Therapy, AngioDynamics.

Key results

  • IRE is primarily nonthermal and uses high-voltage electrical pulses between needle electrodes in the vicinity of the tumor. The treatment damages the cellular membrane, leading to programmed cell death.
  • 40 patients had locally advanced pancreatic cancer, while 10 had local recurrence following pylorus-preserving pancreaticoduodenectomy or distal pancreatectomy and splenectomy.
  • 34 subjects received chemotherapy ahead of IRE, mostly FOLFIRINOX (oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin; n=28; 2-15 cycles).
  • Overall complication rate, 58%.
  • Median OS was 17 (95% CI, 15-19) months, which was higher than the target median OS of 11.6 months based on treatment with chemotherapy alone. OS was similar between patients with previous FOLFIRINOX treatment and those treated with gemcitabine or no chemotherapy (HR, 1.1; P=.70).
  • No tumors were downstaged to resection after IRE.

Limitations

  • Small population. No controls.