Chemoradiotherapy Before Surgery May Improve Outcomes in Resectable Pancreatic Cancer

CHICAGO—Chemoradiotherapy prior to surgery for patients with borderline resectable pancreatic cancer significantly improves outcomes versus immediate surgery, according to preliminary data presented during the 2018 American Society of Clinical Oncology Annual Meeting on Monday, June 4.¹

The standard of care among patients with pancreatic cancer that is resectable or borderline resectable is surgery followed by adjuvant chemotherapy. Evidence suggests, however, that neoadjuvant chemoradiotherapy may afford benefit, but this hypothesis requires further validation.

In the phase 3 PREOPANC-1 study, 246 patients were randomly assigned to receive preoperative chemoradiotherapy (2.4 Gy for 15 rounds plus gemcitabine 1000 mg/m²) or immediate surgery; both study arms received adjuvant chemotherapy. Baseline characteristics were comparable between the treatment groups. Overall, 127 and 119 patients were assigned to immediate surgery or preoperative chemoradiotherapy, respectively.

Patients who received neoadjuvant chemoradiotherapy had a significantly improved median overall survival (OS) of 17.1 months compared with 13.5 months among patients who underwent immediate surgery (hazard ratio [HR], 0.74; P = .047).

Other outcomes were significantly improved in the experimental arm compared with the control arm as well, including R0 resection rate (31% vs 63%; P ≤ .001), median disease-free survival (7.9 vs 11.2 months; HR, 0.71; P = .023), median distant metastases-free interval (10.2 vs 17.1 months; HR, .71; P = .013), and median locoregional recurrence-free interval (11.8 vs not reached; HR 0.55; P < .002). The resection rate was 72% and 62% in the immediate surgery group versus neoadjuvant chemoradiotherapy group, respectively (P = .15).

A subset analysis also revealed that among patients who underwent R0/R1 resection, patients who received preoperative chemoradiotherapy had a significantly improved median OS of 42.2 months compared with 16.8 (P < .001).

There was an increase in the rate of serious adverse events among patients who received preoperative radiochemotherapy compared with immediate surgery, but this observation was not significant (46% vs 39%; P = .28).

The authors noted these findings were preliminary, but concluded that the “results of the PREOPANC trial suggest a benefit of neoadjuvant radiochemotherapy over upfront surgery.”

Read more of Cancer Therapy Advisor‘s coverage of the American Society of Clinical Oncology (ASCO) 2018 meeting by visiting the conference page.

Reference

1. Van Tienhoven G, Versteijne E, Suker M, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC-1): A randomized, controlled, multicenter phase III trial. Oral presentation at the American Society of Clinical Oncology 2018 Meeting; June 1-5, 2018. Chicago; IL.