Chemotherapy Alone Post Surgery Provides Better Value in Pancreatic Cancer

Research led by investigators at the Vanderbilt University Medical Center has found that chemotherapy alone, following surgery in patients with pancreatic cancer, improved survival compared with patients who received a combination of chemotherapy and radiation.

The fourth most common cause of cancer death in the United States, about 48,960 new cases of pancreatic cancer are diagnosed every year, according to the CDC. Additionally, lack of symptoms during early stages of the disease means most patients already have advanced disease at the time of diagnosis, and only 10 to 15% of patients are eligible for surgery that may cure the disease. Even among surgery patients, 50 to 90% of patients have a recurrence of cancer and most die of the disease. Because so many patients experience disease recurrence, 6 months of systemic chemotherapy following surgery is the standard of care, but some physicians add chemoradiation.

To evaluate the outcomes following radiation versus chemoradiation, researchers followed 1130 patients for a median period of 18 months of adjuvant treatment, post surgery. “The goal was to determine how adjuvant therapy affects disease recurrence,” said Alexander Parikh, MD, MPH, associate professor of Surgery and director of the Vanderbilt Pancreas Center, who led the study, in a statement.

According to the results published in the Journal of the American College of Surgeons, compared with patients undergoing surgery alone, those who received chemotherapy following surgery had better overall survival (OS), but not the patients who received chemoradiation. Adjuvant chemotherapy improved survival by 29% over surgery, authors report. Further, while both chemotherapy and chemoradiation reduced the incidence of local disease recurrence by 41% and 49%, respectively, chemotherapy—not chemoradiation—reduced the probability of distant disease metastasis by 26%.

The authors conclude that adjuvant chemotherapy provided an OS advantage likely related to its effect on reducing both local and distant disease recurrence, while adjuvant, which reduces local recurrence alone, has less impact on OS. They go on to propose that future studies and treatment protocols should emphasize treating patients with pancreatic cancer with adjuvant chemotherapy alone.

“We treat a high volume of patients with pancreatic cancer here at Vanderbilt, so it is crucial to provide treatment based on the best scientific information. Unless we get better evidence to show that radiation helps in resected pancreatic cancer, we believe adjuvant therapy should be confined to chemotherapy after surgery,” according to Parikh.

Reference

Parikh AA, Maiga A, Bentrem D, et al. Adjuvant therapy in pancreas cancer: does it influence patterns of recurrence [published online February 16, 2016]? J Am Coll Surg. pii: S1072-7515(16)00015-6.