Pancreatic cancer: upfront neoadjuvant chemotherapy beats surgery followed by chemotherapy

  • Lee YS & al.
  • Sci Rep
  • 30 Oct 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A meta-analysis suggests neoadjuvant therapy (NAT) confers better survival advantage than upfront surgery followed by adjuvant chemotherapy in resectable pancreatic cancer.

Why this matters

  • The authors attempted to compensate for selection bias, which may have plagued previous retrospective studies.

Study design

  • Meta-analysis (14 studies; n=2699 neoadjuvant therapy, 6992 upfront surgery).
  • Funding: Korean government.

Key results

  • NAT was associated with better OS in resectable disease (HR, 0.80; P=.002), but there was significant heterogeneity in the included studies (chi2=21.02; P=.070; I2=38%).
  • In subanalyses designed to reduce selection bias, there was a significant advantage with NAT in a per protocol analysis (12 studies; HR, 0.72; P<.001 but not in an intention-to-treat analysis studies hr p=".610).</li">
  • The loss of survival advantage in the ITT analysis may be the result of a higher presurgical attrition rate in the NAT group (36.3% vs 17.3%).
  • 4 studies looked at NAT followed by resection (n=2177) and surgery followed by adjuvant chemotherapy (n=4545). A meta-analysis showed a survival advantage with NAT (HR, 0.82; P<.01 with no significant between-study heterogeneity>2=3.57; P=.310; I2=16%).

Limitations

  • Included studies were retrospective.