Neoadjuvant chemoradiotherapy improves overall survival (OS), compared with upfront surgery, in patients with resectable or borderline resectable pancreatic cancer, updated data suggest.1

The 5-year OS rate was 14% higher among patients treated with neoadjuvant chemoradiotherapy in the phase 3 PREOPANC trial. These results were published in the Journal of Clinical Oncology.

The PREOPANC trial enrolled 248 patients with resectable or borderline resectable pancreatic cancer. They were randomly assigned to receive neoadjuvant gemcitabine-based chemoradiotherapy (n=120) or upfront surgery (n=128), each followed by adjuvant gemcitabine.


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The initial results showed no significant difference in OS at a median follow-up of 27 months.2

In the current analysis, with a median follow-up of 59 months, OS was significantly longer in the neoadjuvant chemoradiotherapy arm.1 The median OS was 15.7 months in the neoadjuvant arm and 14.3 months in the upfront surgery arm (hazard ratio [HR], 0.73; 95% CI, 0.56-0.96; P =.025).

The 5-year OS rate was 20.5% with neoadjuvant chemoradiotherapy and 6.5% with upfront surgery. The OS benefit with neoadjuvant chemoradiotherapy was observed across all prespecified subgroups, including baseline age, sex, WHO performance, resectability, tumor size, and level of serum carbohydrate antigen 19-9.

In addition to improved OS, patients in the neoadjuvant chemoradiotherapy arm had improved disease-free survival (HR, 0.69; 95% CI, 0.53-0.91; P =.009) and locoregional failure-free interval (HR, 0.57; 95% CI, 0.39-0.83; P =.004). The between-arm difference was not significant for distant metastases-free interval (HR, 0.74; 95% CI, 0.54-1.03; P =.070).

Serious adverse events occurred in 52% of patients in the neoadjuvant chemoradiotherapy arm and 41% of those in the upfront surgery arm (P =.096). Previously published results showed that major surgical complications and postoperative mortality were similar between the treatment arms.3

The researchers suggested that, although these data showed improved outcomes with a gemcitabine-based chemoradiotherapy regimen, “the optimal neoadjuvant regimen warrants further investigation.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

References

  1. Versteijne E, van Dam JL, Suker M, et al. Neoadjuvant chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer: Long-term results of the Dutch randomized PREOPANC trial. J Clin Oncol. Published online January 27, 2022. doi:10.1200/JCO.21.02233
  2. Versteijne E, Suker M, Groothuis K, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: Results of the Dutch randomized phase III PREOPANC trial. J Clin Oncol. 2020;38(16):1763-1773. doi:10.1200/JCO.19.02274
  3. van Dongen JC, Suker M, Versteijne E, et al. Surgical complications in a multicenter randomized trial comparing preoperative chemoradiotherapy and immediate surgery in patients with resectable and borderline resectable pancreatic cancer (PREOPANC trial). Ann Surg. Published online November 12, 2020. doi:10.1097/SLA.0000000000004313