Pancreatic cancer: study identifies 'sweet spot' for starting adjuvant therapy

  • Ma SJ & al.
  • JAMA Netw Open
  • 2 Aug 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Commencement of adjuvant therapy 28-59 days after resection was associated with the best survival outcomes in patients with stage I/II pancreatic cancer.
  • Initiation after 59 days was linked to better survival than no adjuvant therapy.

Why this matters

  • Previous studies showed no survival difference with delay, but may have missed the optimal window.

Study design

  • Retrospective analysis of 7548 patients from the National Cancer Database.
  • Funding: None disclosed.

Key results

  • 5453 patients (72.2%) received adjuvant therapy, 42.7% in the 40-60-day range.
    • 269 started early (
    • 3048 were in the reference group (28-59 days).
    • 2136 started late (>59 days).
  • Median follow-up was 38.6 months.
  • The lowest mortality was associated with the reference group (days 28-59):
    • Early vs reference mortality: HR, 1.17; P=.03.
    • Late vs reference mortality: HR, 1.09; P=.008.
  • In propensity-matched pairs, the reference group had better 2-year OS:
    • vs early (268 pairs): 52.5% vs 45.1% (P=.02), and
    • vs late (2042 pairs): 51.3% vs 45.4% (P=.01).
  • The late group had better OS vs surgery alone in a multivariate analysis (HR, 0.75; P<.001 and in an analysis of matched pairs os vs p>

Limitations

  • Retrospective analysis.