Continuing chemotherapy after surgery improves pancreatic cancer survival
A major international study shows that pancreatic cancer patients who received the same chemotherapy regimen before and after surgery lived significantly longer than those who stopped treatment. The findings could reshape how oncologists design multi-phase treatment plans and influence which patients proceed to surgery.
Originaltitel: Benefit of adjuvant chemotherapy for resected pancreatic cancer following neoadjuvant FOLFIRINOX or Gemcitabine-Nab-paclitaxel: a multinational analysis.
Fortsattning av samma kemoterapiregim efter operation föreslås nu kunna öka överlevnaden hos patienter med borderline-resektabel eller lokalt avancerad bukspottskörtelcancer. En multinationell analys på 834 patienter med kurativ resektion efter neoadjuvant behandling visar att patienter som fick FOLFIRINOX både före och efter operation uppnådde medianoverleven på 42,0 månader jämfört med 25,8 månader utan adjuvant kemoterapi. Denna fördel var regimspecifik: byte till gemcitabin-nab-paklitaxel gav ingen överlevnadsfördel, och fortsatt gemcitabin-nab-paklitaxel efter neoadjuvant samma terapi visade inte heller överlevnadsvinst. Studien från universitet i Murcia, Zürich, Münster och Göteborg talar för att inköpare och klinikansvariga bör uppmärksamma regimkontinuitet vid planering av adjuvant behandling. Fortsatt utredning behövs innan riktlinjer uppdateras.
BACKGROUND: The survival benefit of adjuvant chemotherapy (AC) for pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy (NAT) and resection remains controversial. Previous studies often pooled diverse disease stages or chemotherapy regimens, potentially obscuring regimen-specific outcomes. We sought to investigate the association of AC with overall survival (OS) among patients with resected borderline resectable (BRPC) or locally advanced pancreatic cancer (LAPC), stratified by specific neoadjuvant and adjuvant regimens. METHODS: This multinational, retrospective cohort study included 834 patients with BRPC/LAPC who underwent curative-intent resection following NAT with either FOLFIRINOX or gemcitabine plus nab-paclitaxel (Gem/Nab). Propensity score matching (1:1) was utilized to minimize selection bias. The primary outcome was OS, analyzed using Kaplan-Meier methods and Cox proportional hazards models. RESULTS: Among 834 patients, 605 received neoadjuvant FOLFIRINOX and 229 received neoadjuvant Gem/Nab. In the matched analysis for the neoadjuvant FOLFIRINOX cohort, continuation of adjuvant FOLFIRINOX was associated with longer OS compared with no AC (median OS, 42.0 vs. 25.8 months; HR, 0.58; 95% CI, 0.43-0.79; p < 0.001). In contrast, switching to adjuvant Gem/Nab did not confer a survival benefit in this group (HR, 0.84; 95% CI, 0.61-1.15; p = 0.27). For patients receiving neoadjuvant Gem/Nab, adjuvant Gem/Nab or other regimens was not associated with improved OS (HR, 0.92; 95% CI, 0.64-1.34; p = 0.69). CONCLUSIONS: Survival benefits of adjuvant chemotherapy in resected BRPC/LAPC may be regimen-dependent. Postoperative continuation of FOLFIRINOX appeared to be associated with a survival advantage, whereas regimen de-escalation or adjuvant chemotherapy following neoadjuvant Gem/Nab demonstrated no clear benefit.