PDAC: new evidence for adjuvant therapy

  • Perri G & al.
  • Ann Surg
  • 31 Dec 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Adjuvant chemotherapy is associated with better outcomes in resected pancreatic ductal adenocarcinoma (PDAC) treated with neoadjuvant therapy.

Why this matters

  • National guidelines suggest consideration of adjuvant therapy in patients who have undergone neoadjuvant therapy, but no high-level data support this position.

Study design

  • Propensity-score matched analysis (n=245; 63% adjuvant chemotherapy).
  • Funding: NIH.

Key results

  • Compared with the no-adjuvant therapy group, the adjuvant chemotherapy group:
    • Underwent fewer cycles of neoadjuvant chemotherapy (median, 3 vs 4; P<.01>
    • More often received only (chemo)radiotherapy (46% vs 21%; P<.01>
    • Had a higher median CA 19-9 level before surgery (32 vs 24 U/mL; P=.03); and
    • Had a larger median tumor diameter (2.8 vs 2.4 cm; P=.01).
  • Adjuvant chemotherapy trended toward association with a better OS (HR, 0.7; P=.06).
  • The propensity-matched cohort included 61 patients who underwent adjuvant chemotherapy and 61 who did not.
    • Median OS trended toward being higher in the adjuvant chemotherapy group: 42 vs 32 months; P=.06 (HR, 0.55; P=.05).
    • Median recurrence-free survival was longer in the adjuvant chemotherapy group: 17 vs 12 months; P=.04 (HR, 0.53; P=.038).

Limitations

  • Retrospective analysis.