Is pancreatic cancer an inherently systemic disease?

  • Jones RP & al.
  • JAMA Surg
  • 4 Sep 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Secondary analysis.
  • Less relevant in the era of adjuvant FOLFIRINOX  (fluorouracil, leucovorin, oxaliplatin, and irinotecan).