Multiagent Adjuvant Therapy Ups Pancreatic Cancer Survival

TOPLINE:

Adjuvant combination leucovorin calcium, fluorouracil, irinotecan hydrochloride, and oxaliplatin (FOLFIRINOX) and other multiagent chemotherapy regimens boost overall survival (OS) in patients with resected pancreatic adenocarcinoma after preoperative FOLFIRINOX. Single-agent adjuvant chemotherapy shows no significant survival benefit.

METHODOLOGY:

• Researchers conducted a retrospective cohort study across 48 centers in 20 countries from 2010 to 2018 of patients with localized pancreatic adenocarcinoma treated with 2-11 cycles of FOLFIRINOX.
• Analysis included 767 patients who underwent resection, with a median age of 62 years (interquartile range, 55-67 years) and 52.7% male participants.
• Primary outcome measure was OS, calculated from a 3-month landmark postsurgery.
• Cox regression analysis, including interaction analyses, was performed to investigate the association of adjuvant chemotherapy with OS.

TAKEAWAY:

• Adjuvant chemotherapy was independently associated with prolonged OS (hazard ratio [HR], 0.66; 95% CI, 0.49-0.87).
• The association of adjuvant chemotherapy appeared lower among patients receiving eight or more cycles of preoperative FOLFIRINOX, those with radiological response, and those with ypN0 disease.
• Compared with no adjuvant chemotherapy, both adjuvant FOLFIRINOX (HR, 0.57; 95% CI, 0.40-0.80) and other multiagent adjuvant regimens (HR, 0.61; 95% CI, 0.41-0.92) were associated with prolonged OS.
• Single-agent adjuvant chemotherapy showed no significant association with improved OS (HR, 0.75; 95% CI, 0.55-1.03).

IN PRACTICE:

“In patients for whom multiagent adjuvant chemotherapy is not feasible at all, extra caution with single-agent chemotherapy is advised, with regard to unnecessary treatment burden considering the possible lack of [OS] benefit. Herein, the number of cycles of preoperative chemotherapies should be taken into account, which might influence the association of adjuvant chemotherapy with OS,” wrote the authors of the study.

SOURCE:

The study was led by Thomas F. Stoop, MD, and Marc G. Besselink, MD, PhD, MSc, from Amsterdam UMC, location University of Amsterdam, Department of Surgery in Amsterdam, the Netherlands. It was published online on January 23 in JAMA Oncology.

LIMITATIONS:

The reasons for choosing a specific adjuvant therapy other than FOLFIRINOX regimens or forgoing adjuvant therapy were unknown, suggesting the outcomes may be influenced by selection bias. Sample size constraints prevented detailed analysis of associations between specific numbers of preoperative cycles and different adjuvant regimens. Some clinicopathological parameters were excluded from analysis due to > 20% of data being unavailable for analysis.

DISCLOSURES:

Stoop received grants from KWF Dutch Cancer Society, Deltaplan Alvleesklierkanker/Maag-Level-Darm Stichting, Cancer Center Amsterdam, and het Cultuurfonds unrelated to this work. Coauthor Atsushi Oba, MD, PhD, disclosed receiving grants from Bayer Yakuhin outside the submitted work. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.