PDAC: neoadjuvant chemotherapy ups resection, survival rates

  • Maggino L & al.
  • JAMA Surg
  • 24 Jul 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • In a real-world setting, primary chemotherapy completion was associated with a higher resection rate and better OS in patients with borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).

Why this matters

  • Real-world evidence for primary chemotherapy supports clinical trial results.

Study design

  • Prospective, Italian observational cohort study of 680 patients; 39.3% with BR PDAC, and 60.7% with LA PDAC.
  • Funding: Associazione Italiana per la Ricerca sul Cancro; Italian Ministry of Health; FP7 European Community Grant Cam-Pac.

Key results

  • 92.9% underwent chemotherapy, 23.9% underwent surgery, 15.1% underwent resection (BR, 24.1%; LA, 9.0%).
  • Modified/original FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan) was most commonly used (45.6%), followed by gemcitabine plus nanoparticle albumin-bound (nab)-paclitaxel (21.6%).
  • Treatment completion rate, 71.6%.
  • Resection was associated with completion of chemotherapy (OR, 14.323; P<.001>
  • Resection after treatment completion was more common with BR PDAC (OR, 7.216; P=.001) and CA19-9 response (OR, 5.010; P=.001).
  • Median overall OS, 12.8 (95% CI, 11.7-13.9) months.
  • With resection, median OS based on original status was:
    • BR: 35.4 (95% CI, 27.0-43.7) months.
    • LA: 41.8 (95% CI, 27.5-56.1) months.
  • Factors for prolonged survival included treatment completion (HR, 0.390; P<.001 complementary radiotherapy p=".001)," and resection>

Limitations

  • Exclusion of patients with resectable disease.