Pancreatic cancer has a dismal prognosis with a 5-year survival rate of 9%. Even after upfront surgical resection combined with adjuvant chemotherapy, 75% of patients relapse within 2 years. However, results from a recent study show that adjuvant chemotherapy can improve outcomes in patients with pathology-proven node-positive pancreatic cancer who received neoadjuvant folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) and resection, providing a potential new standard of care that may prolong survival for this subgroup of patients.
In this international, multicenter, retrospective cohort study, results of which are published in JAMA Oncology, 520 patients with resectable pancreatic cancer, borderline resectable pancreatic cancer, and locally advanced pancreatic cancer were enrolled. Overall survival (OS) was defined as the time starting from surgery plus 3 months, which was the time patients became qualified for adjuvant therapy.
In total, 343 participants received adjuvant chemotherapy, of which 68 received FOLFIRINOX, 201 received gemcitabine-based chemotherapy, 14 received capecitabine, 45 received a combination or other agents, and 15 were administered an unknown type of adjuvant chemotherapy. Overall survival was found to be 38 months after diagnosis and 31 months after surgery. Only in patients with pathology-proven node-positive disease was adjuvant chemotherapy associated with a significantly increased OS (26 vs 13 months). In patients with node-negative disease, adjuvant chemotherapy did not significantly increase OS (38 vs 54 months).
The study authors, led by Stijn van Roessel, MD, MSc, of the Department of Surgery in the Cancer Center Amsterdam of the Amsterdam University Medical Center, concluded, "These results suggest that adjuvant chemotherapy after neoadjuvant FOLFIRINOX and resection of pancreatic cancer was associated with improved survival only in patients with pathology-proven node-positive disease. Future randomized studies should be conducted to confirm this finding."
For More Information
Roessel SV, Veldhuisen EV, Klompmaker S, et al (2020). Evaluation of adjuvant chemotherapy in patients with resected pancreatic cancer after neoadjuvant FOLFIRINOX treatment. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2020.3537
Image credit: Ed Uthman. Licensed under CC BY 2.0