Top Line: Do patients with resected pancreatic cancer who received neoadjuvant chemotherapy benefit from additional adjuvant chemotherapy?
The Study: For patients with resected pancreatic cancer, either adjuvant gemcitabine + capecitabine (25.5→ 28 months) or adjuvant FOLFIRINOX (35→ 54.4 months) improve survival over gemcitabine alone. Both regimens are also used if neoadjuvant therapy is chosen. This large retrospective cohort study asks just that question for patients who received neoadjuvant FOLFIRINOX. They assembled data from over 500 patients from 31 centers in 19 countries. Among these, 61% had R0 resection, and 50% had LN+ disease. Two-thirds received adjuvant chemotherapy. Most of these (59%) received gemcitabine-based therapy, 20% received additional FOLFIRINOX, and the rest received other regimens. Patients who received chemo had higher rates of adverse features like R1 resection and LN+ disease, but they also had better performance status. There was no difference in median OS between patients who did or did not receive adjuvant chemo. Among those with node-positive disease, though, adjuvant chemo was associated with improved OS (13→ 26 months). Both FOLFIRINOX and gemcitabine-based regimens were associated with improved OS for LN+ patients.
TBL: After neoadjuvant FOLFIRINOX and resection for pancreatic cancer, it’s mainly patients with node-positive disease who appear to benefit from additional chemotherapy. | van Roessel, JAMA Oncol 2020