Pancreatic cancer: no survival benefit for early vs later adjuvant chemotherapy

  • Petrelli F & al.
  • Cancers (Basel)
  • 17 Apr 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Starting adjuvant chemotherapy (ACT) within 6-8 weeks of surgery was associated with improved survival in colorectal and gastric cancer, but not pancreatic cancer.

Why this matters

  • There is a lack of prospective clinical trials examining whether delays past 6-8 weeks can affect results in these cancers.

Study design

  • Systematic review and meta-analysis of 3 post hoc analyses of randomized controlled trials, 1 prospective study, and numerous retrospective studies (34 studies; n=141,853).
  • Funding: No external funding.

Key results

  • For colorectal cancer, there was increased risk for mortality with a delay (combined HR for delayed vs earlier ACT, 1.27; P<.001 with moderately high heterogeneity>2=70%; P<.001>
  • An analysis that sequentially removed the 4 studies with the highest weight yielded statistically significant HRs ranging from 1.25 to 1.28.
  • For gastric cancer, there was increased risk for mortality with ACT delay (combined HR, 1.2; P=.01), with high heterogeneity (I2=90%; P<.001>
  • An analysis that removed the study with the highest weight yielded an HR of 1.41 (P=.09).
  • For pancreatic cancer, there was no significantly increased risk with delayed ACT (combined HR, 1; P=.37), with low heterogeneity (I2=20%; P<.001>

    Limitations

    • Most included studies were retrospective.