Better exposure to chemotherapy can lead to increased survival as well as an increased rate of microscopic negative margin resection.
Long-term results from the Dutch randomized controlled trial PREOPANC confirm that neo-adjuvant chemotherapy confers a survival advantage. The patients With resectable and borderline pancreatic cancer.
The new adjuvant therapy remains controversial in these patients, which account for 15% of pancreatic cancer cases.
Historically, these patients were treated with surgery followed by adjuvant chemotherapy, but only about half of them The patients Receiving adjuvant chemotherapy for early recurrence, surgical complications, or worsening of the disease.
Neoadjuvant chemotherapy is thought to increase the proportion of patients who receive chemotherapy. Better exposure to chemotherapy can increase Survival It can also increase the resection rate microscopically with negative margins.
New adjuvant chemotherapy is becoming increasingly common, but practice relies on retrospective analyzes and small phase II trials.
“This randomized phase III trial demonstrates a long-term survival benefit with neoadjuvant therapy compared to primary surgery in pancreatic cancer patients Published online January 27, the researchers wrote in the study magazine Clinical Oncology. . “The The effect of neoadjuvant chemotherapy It was consistent across all subgroups, including resectable disease They added.”
The new data represent a long-term follow-up of 246 patients who were randomly assigned to receive neoadjuvant chemotherapy or primary surgery.
Short-term data released in 2020 showed Tendencies Towards Better Survivalbut no statistically significant difference with a median of 27 months of follow-up.
On update, after an average follow-up of 59 months, The patients The neo-adjuvant chemotherapy group had a better overall survival (hazard ratio [HR]0.73; s = 0.025) and Survival The overall risk at 5 years was greater in the neo-adjuvant chemotherapy group (20.5%; confidence interval .). [IC] 95%, 14.2%-29.8%) of the primary surgery group (6.5%; 95% CI, 3.1%-13.7%).
Subgroup analyzes found an advantage Survival of initial chemotherapy Enter The patients With resectable borderline tumors (HR, 0.67; s = 0.045), and a trend toward better survival among The patients With resectable tumors (HR, 0.79; s = 0.23).
There was a trend towards more serious adverse events in the initial chemotherapy group (52% vs 41%; s = 0.096). There was no difference in major surgical complications or postoperative mortality.
The study found high rates of progression during the first year in both the neo-adjuvant chemotherapy group and the primary surgery group. “It appears that our new program was not able to prevent many of these early developments, and more effective programs are warranted,” the authors wrote.
Survival outcomes were lower than those in the adjuvant trials, possibly due to differences in patient groups.
Adjunctive studies generally recruit patients who have recovered well from resection and who have no early signs of recurrence and thus have a more favorable prognosis.
The long-term results of PREOPANC are consistent with four previous studies that compared neoadjuvant chemotherapy with primary surgery.
The study limitation was that gemcitabine monotherapy was used as an adjunct, and this regimen is now considered obsolete.
Consulting resource here.