- An analysis of the ESPAC-4 trial shows similar patterns of local and distant recurrence in pancreatic ductal adenocarcinoma (PDAC) after resection plus adjuvant therapy, but questions remain.
Why this matters
- PDAC may behave as a systemic disease, but the differing effect of adjuvant therapy on local vs distant recurrence rate suggests that local recurrence may be unique, according to an accompanying editorial.
- Secondary analysis of a study in which 730 PDAC patients underwent resection and were randomly assigned to adjuvant therapy with gemcitabine±capecitabine.
- Funding: Cancer Research UK, Royal Liverpool and Broadgreen University Hospitals National Health Services Trust.
- Compared with gemcitabine monotherapy, combination therapy reduced local recurrence (HR, 0.77; P=.04), but not distant recurrence (HR, 1.01; 95% CI, 0.782-1.295).
- Gemcitabine+capecitabine reduced death following recurrence vs gemcitabine alone (HR, 0.79; P=.03).
- Distant recurrence occurred sooner than local recurrence (median, 11.27 vs 13.57 months; HR, 1.20; P=.04).
- There was no significant difference in median survival after local recurrence (9.36 months) and distant recurrence (8.94 months; HR, 0.89; P=.27).
- There was no significant difference in median OS between distant-only recurrence, local with distant recurrence, and local-only recurrence.
- Secondary analysis.
- Less relevant in the era of adjuvant FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan).