Perioperative adaptive dynamic therapy (ADT) can improve overall survival (OS) in patients with localized pancreatic cancer, according to research published in JAMA Network Open.
ADT was defined as selecting chemotherapy based on the patient’s response to neoadjuvant therapy, as measured by CA19-9 levels and/or pathologic response.
Researchers found that ADT was associated with an 11-month improvement in OS.
For this study, the researchers retrospectively analyzed patients with localized pancreatic cancer who were treated with either gemcitabine/nab-paclitaxel or fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) preoperatively between 2010 and 2019.
The study included 322 consecutive patients (50% women), with a mean age of 65.1 years. There were 219 patients in the ADT group and 103 patients in the non-ADT group.
Patients in the ADT group remained on or switched to an alternative neoadjuvant regimen based on CA19-9 response and had their adjuvant therapy selected based on CA19-9 and/or pathologic response. The non-ADT group had their chemotherapy regimen selected independent of response.
The median follow-up was 49 months. The ADT group had a greater median decrease in CA19-9 levels (-80% vs -45%; P <.001), a higher incidence of complete or near-complete tumoral response (12% vs 2%; P = .007), and fewer lymph node metastases (median, 1 vs 2; P =.046).
OS was significantly prolonged in the ADT group compared with the non-ADT group (38.7 months vs 26.5 months; P =.03). In a multivariate analysis, ADT was independently associated with an improvement in OS (hazard ratio, 0.73; 95% CI, 0.53-0.99; P =.04).
In an inverse probability weighted analysis, the average treatment effect of ADT was an OS increase of 11.1 months (95% CI, 1.5-20.7; P =.02).
“This study highlights the importance of an individualized perioperative therapy for pancreatic cancer in which the choice of chemotherapy regimen is dictated by an in vivo assessment of response to neoadjuvant therapy,” the researchers concluded.
Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
AlMasri S, Zenati M, Hammad A, et al. Adaptive dynamic therapy and survivorship for operable pancreatic cancer. JAMA Netw Open. Published online June 23, 2022. doi:10.1001/jamanetworkopen.2022.18355