Meeting NewsPerspective

Preoperative chemoradiotherapy improves pancreatic cancer survival

CHICAGO — Preoperative chemotherapy with radiation demonstrated a significant survival benefit compared with surgery alone among patients with borderline resectable pancreatic cancer, according to preliminary results of the phase 3 randomized controlled PREOPANC trial presented at the ASCO Annual Meeting.

More patients who received chemoradiotherapy before surgery achieved 2-year OS than patients who started therapy with surgery (42% vs. 30%).

“Patients with pancreatic cancer have a very poor prognosis. Surgical removal is only possible in a minority of patients and is followed by adjuvant chemotherapy as the standard of care — up until now,” Geertjan Van Tienhoven, MD, PhD, radiation oncologist in the department of radiation oncology at Academic Medical Center in Amsterdam, said during a press conference.

Previously data suggested neoadjuvant treatment may be beneficial for patients with pancreatic cancer.

Van Tienhoven and colleagues conducted a multicenter trial to evaluate and compare preoperative chemoradiotherapy (n = 119) with immediate surgery (n = 127) among patients with borderline resectable pancreatic cancer. All patients received adjuvant chemotherapy.

Preoperative chemoradiotherapy included 15 doses of 2.4 Gy radiation plus 1,000mg/m² gemcitabine on days 1, 8 and 15, preceded and followed by one cycle of gemcitabine.

OS served as the primary endpoint. Secondary endpoints included resection rate, DFS, distant metastases-free interval, locoregional recurrence-free interval and toxicity.

Results of the intention-to-treat analysis showed OS significantly increased with preoperative chemoradiotherapy (median, 17.1 months vs. 13.7 months; HR = 0.74; P = .074).

Chance for microscopically complete removal of the tumor during surgery was 63% with preoperative treatment vs. 31% with immediate surgery.

Preoperative treatment was also associated with prolonged DFS (median, 11.2 months vs. 7.9 months; HR = 0.67; P = .01), distant metastases-free interval (median, 17.1 months vs. 10.2 months; HR = 0.71; P = .013) and locoregional recurrence-free interval (median, 11.2 months vs. not reached; HR = 0.55; P = .002).

A subgroup analysis including patients who underwent successful resection showed a median OS of 42.1 months with preoperative chemoradiotherapy vs. 16.8 months with immediate surgery.

“I must stress that these are preliminary findings and we will need 26 more events before the final analysis can meet statistical significance,” Van Tienhoven said. “These final results have to be awaited before we can draw a definitive conclusion.” – by Jennifer Southall

Reference:

Van Tienhoven G, et al. LBA4002. Presented at: ASCO Annual Meeting; June 1-5, 2018; Chicago.

Disclosures: The study was funded by the Dutch Cancer Society KWF. Van Tienhoven reports no relevant financial disclosures. Please see the abstract for all other author’s relevant financial disclosures.

 

 

CHICAGO — Preoperative chemotherapy with radiation demonstrated a significant survival benefit compared with surgery alone among patients with borderline resectable pancreatic cancer, according to preliminary results of the phase 3 randomized controlled PREOPANC trial presented at the ASCO Annual Meeting.

More patients who received chemoradiotherapy before surgery achieved 2-year OS than patients who started therapy with surgery (42% vs. 30%).

“Patients with pancreatic cancer have a very poor prognosis. Surgical removal is only possible in a minority of patients and is followed by adjuvant chemotherapy as the standard of care — up until now,” Geertjan Van Tienhoven, MD, PhD, radiation oncologist in the department of radiation oncology at Academic Medical Center in Amsterdam, said during a press conference.

Previously data suggested neoadjuvant treatment may be beneficial for patients with pancreatic cancer.

Van Tienhoven and colleagues conducted a multicenter trial to evaluate and compare preoperative chemoradiotherapy (n = 119) with immediate surgery (n = 127) among patients with borderline resectable pancreatic cancer. All patients received adjuvant chemotherapy.

Preoperative chemoradiotherapy included 15 doses of 2.4 Gy radiation plus 1,000mg/m² gemcitabine on days 1, 8 and 15, preceded and followed by one cycle of gemcitabine.

OS served as the primary endpoint. Secondary endpoints included resection rate, DFS, distant metastases-free interval, locoregional recurrence-free interval and toxicity.

Results of the intention-to-treat analysis showed OS significantly increased with preoperative chemoradiotherapy (median, 17.1 months vs. 13.7 months; HR = 0.74; P = .074).

Chance for microscopically complete removal of the tumor during surgery was 63% with preoperative treatment vs. 31% with immediate surgery.

Preoperative treatment was also associated with prolonged DFS (median, 11.2 months vs. 7.9 months; HR = 0.67; P = .01), distant metastases-free interval (median, 17.1 months vs. 10.2 months; HR = 0.71; P = .013) and locoregional recurrence-free interval (median, 11.2 months vs. not reached; HR = 0.55; P = .002).

A subgroup analysis including patients who underwent successful resection showed a median OS of 42.1 months with preoperative chemoradiotherapy vs. 16.8 months with immediate surgery.

“I must stress that these are preliminary findings and we will need 26 more events before the final analysis can meet statistical significance,” Van Tienhoven said. “These final results have to be awaited before we can draw a definitive conclusion.” – by Jennifer Southall

Reference:

Van Tienhoven G, et al. LBA4002. Presented at: ASCO Annual Meeting; June 1-5, 2018; Chicago.

Disclosures: The study was funded by the Dutch Cancer Society KWF. Van Tienhoven reports no relevant financial disclosures. Please see the abstract for all other author’s relevant financial disclosures.

 

 

    Perspective
    Allyson Ocean

    Allyson Ocean

    These data are very timely as I am currently treating a patient with borderline resectable pancreatic cancer. I now have data in front of me that say I should deliver chemoradiation prior to surgery. This is an important practice-changing study, because more patients are receiving total neoadjuvant therapy — getting all treatment upfront or the majority of treatment upfront including chemotherapy, followed by radiation, surgery and then adjuvant therapy. To see a significant extension in survival with preoperative chemoradiation, supports that we knew we had to do something differently for these patients, as the recurrence rates are so high.

    The data showing 17.1 months vs. 13.7 months median OS with preoperative chemoradiation is impressive. Even more impressive is that this led to better surgery with complete tumor removal. Also, 5-year survival significantly improved.

    It is a no-brainer that patients need to have treatment before surgery and the results speak to the fact that pancreatic cancer is a systemic disease. The risk for metastasis exists long before we even detect the tumor by imaging. There are circulating tumor cells in the bloodstream that need to be treated, even if CT scan looks like the patient can have surgery from the beginning. We need to rid the system of this first, before we even consider performing surgery, because a tumor that looks resectable microscopically does not mean that it is resectable. The fact that these patients have had significant longer survival with neoadjuvant therapy and their survival times are so much better is now practice changing in this patient population.

    • Allyson Ocean, MD
    • New York-Presbyterian Hospital Weill Cornell Medicine

    Disclosures: Ocean reports no relevant financial disclosures.

    See more from ASCO Annual Meeting