Chemo Duration Before Chemoradiation Affects Survival in Pancreatic Cancer

A longer versus shorter duration of chemo has a survival benefit in patients with resected stage I-II or unresected stage III pancreatic cancer, according to a recent National Cancer Database study (Cancer Med. 2019 Jun 10. Epub ahead of print).

“For early stage pancreatic cancer, definitive management is attained through surgical resection followed by adjuvant chemotherapy…with or with- out chemoradiation (CRT). Several key studies have drawn conflicting conclusions regarding the use of CRT in this population,” said Sung J. Ma, MD, Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, and colleagues.

The purpose of this study was to compare the survival outcome of various durations of postoperative chemotherapy prior to chemoradiation.

Pulling National Cancer Database data from 2004 to 2015 for patients with pancreatic adenocarcinoma, 1577 patients were stratified into cohorts by age, tumor size, and then by shorter versus longer duration of chemotherapy. Cohort I-II had 839 patients total, and cohort III had 738 patients; both cohorts included stage I to II and stage III cases, respectively.

Using 1:1 propensity score matching, 610 patients from cohort I-II and 542 patients from cohort III were matched. Notably, after matching, both groups had equal proportion of patients receiving multi-agent chemotherapy.

Overall survival improved in patients who received the longer duration of chemotherapy prior to chemoradiation, based on a multivariate analysis in cohort I-II (hazards ratio [HR], 0.72; P <.001) and cohort III (HR, 0.83; P = .03).

According to Dr Ma and colleagues, this is the first study to show that survival outcomes for both resected stage I-II and unresected stage III pancreatic cancer are improved with a longer versus shorter duration of chemotherapy before chemoradiation.

“Ongoing clinical trials looking at various C and CRT combinations for treating pancreatic cancer, such as RTOG 0848, should provide greater insight into the optimal management for this challenging population,” Dr Ma et al concluded.Kaitlyn Manasterski

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