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Chronic hepatitis B (CHB) remains a major public health concern because of its worldwide distribution and potential adverse sequelae, including cirrhosis and hepatocellular carcinoma (HCC). At a recent symposium held during the GIHep Singapore 2019, Professor Vincent Wong from the Chinese University of Hong Kong and Professor Ray Kim from the Stanford University School of Medicine, Stanford, California, US, discussed antiviral treatments for CHB, with a focus on the novel agent tenofovir alafenamide (Vemlidy®). Dr Tan Poh Seng from the National University Hospital, Singapore, chaired the symposium.
Audrey Abella, 23 Jan 2019
A single infusion of the monoclonal antibody rituximab temporarily delays the clinical onset of rheumatoid arthritis (RA) through B-cell depletion, underpinning the preventive potential of rituximab in RA development especially in high-risk individuals, according to the PRAIRI* study.
26 Nov 2019
Podcast: Professor R. Scott Wright speaks about the potential role of inclisiran in providing durable reductions in LDL-cholesterol levels in patients with atherosclerotic cardiovascular disease.

Add-on neoadjuvant chemo to surgery ups survival in advanced pancreatic cancer

Elaine Soliven
08 Mar 2019

Neoadjuvant chemotherapy (NACT) followed by surgery was significantly associated with better disease-free survival (DFS) and overall survival (OS) in patients with LAPC* compared with upfront surgery, according to a study presented at the ASCO Gastrointestinal Cancers Symposium 2019 (ASCO GI 2019).

This study involved patients with LAPC who received NACT + surgery (n=135, median age 60 years) or upfront surgery alone (n=359, median age 61 years). Of these, 51 percent had gemcitabine-based regimens and 49 percent had FOLFIRINOX as NACT. [ASCO GI 2019, abstract 312]

Patients who underwent NACT + surgery had a significantly longer DFS and OS compared with upfront surgery alone (median, 9.0 vs 7.1 months; p=0.005 and 25.4 vs 17.1 months; p=0.001, respectively).

In a multivariate analysis of DFS and OS from surgical resection, patients in the NACT + surgery group also showed a significantly better DFS (adjusted hazard ratio [adjHR], 0.72, 95 percent confidence interval [CI], 0.56–0.93; p=0.01] and OS (adjHR, 0.73, 95 percent CI, 0.56–0.96; p=0.02) than those in the upfront surgery alone group.

Compared with patients in the upfront surgery alone group, those in the NACT + surgery group had a significantly lower incidence of T3–T4 stage tumours (93 percent vs 99 percent; p=0.001) and N1 stage lymph nodes (49 percent vs 71 percent; p<0.01).

Even though hospital admission rates for surgery were not significantly different between the two treatment groups, a significantly lower rate of surgical complication was noted in patients treated with NACT + surgery compared with upfront surgery alone (27 percent vs 38 percent; p=0.03).

“Although NACT has been widely investigated [in previous studies], the magnitude of the clinical benefit and the potential risk of NACT followed by surgery compared with upfront surgery remains unclear for patients with LAPC,” said study lead author Dr Jun Ho Kang from the Department of Oncology at Asan Medical Center, University of Ulsan College of Medicine in Seoul, Korea.

Kang and colleagues highlighted that this “present study revealed that NACT followed by surgery may provide survival benefit compared with upfront surgery in LAPC without causing significant safety issues.”

“[However,] further prospective studies are needed to validate our results,” they added.

 

*LAPC: Locally advanced pancreatic cancer

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Most Read Articles
27 Nov 2017
The amino sulphonic acid taurine may safely and effectively reduce portal pressure in cirrhotic patients, a study has shown.
Prof. Vincent Wong, Prof. Ray Kim, Dr. Tan Poh Seng, 10 Sep 2019
Chronic hepatitis B (CHB) remains a major public health concern because of its worldwide distribution and potential adverse sequelae, including cirrhosis and hepatocellular carcinoma (HCC). At a recent symposium held during the GIHep Singapore 2019, Professor Vincent Wong from the Chinese University of Hong Kong and Professor Ray Kim from the Stanford University School of Medicine, Stanford, California, US, discussed antiviral treatments for CHB, with a focus on the novel agent tenofovir alafenamide (Vemlidy®). Dr Tan Poh Seng from the National University Hospital, Singapore, chaired the symposium.
Audrey Abella, 23 Jan 2019
A single infusion of the monoclonal antibody rituximab temporarily delays the clinical onset of rheumatoid arthritis (RA) through B-cell depletion, underpinning the preventive potential of rituximab in RA development especially in high-risk individuals, according to the PRAIRI* study.
26 Nov 2019
Podcast: Professor R. Scott Wright speaks about the potential role of inclisiran in providing durable reductions in LDL-cholesterol levels in patients with atherosclerotic cardiovascular disease.