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