Neoadjuvant chemotherapy for pancreatic cancer: Quality over quantity. J Surg Oncol 2023 Jul;128(1):41-50
Date
03/25/2023Pubmed ID
36960919DOI
10.1002/jso.27265Scopus ID
2-s2.0-85152449940 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
BACKGROUND AND OBJECTIVES: The ideal duration of neoadjuvant chemotherapy (NACT) in patients with localized pancreatic adenocarcinoma (PDAC) treated with curative intent is unclear. We sought to determine the prognostic significance of both duration of NACT and Carbohydrate Antigen 19-9 (CA19-9) normalization to NACT.
METHODS: We examined patients with resectable and borderline resectable PDAC treated with NACT and chemoradiation. Patients were compared by NACT duration (2 vs. 4 months) and by CA19-9 normalization after NACT.
RESULTS: Among 171 patients, 83 (49%) received 2 months of NACT, and 88 (51%) received 4 months. After NACT completion, 115 (67%) patients had persistently elevated CA19-9, and 56 (33%) had normalized. Of the 125 patients who had successful surgery, 73 (58%) had normalized CA19-9 postoperatively. Duration of NACT was not associated with overall survival (OS) while CA19-9 normalization after NACT (regardless of duration) was associated with improved OS (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.35-0.89, p = 0.02). Adjuvant chemotherapy was associated with improved OS among patients without CA19-9 normalization after NACT (HR 0.42, CI 0.20-0.86, p = 0.02) but not among those that normalized, independent of duration.
CONCLUSIONS: CA19-9 normalization after NACT is a clinically significant endpoint of treatment; patients without CA19-9 normalization may benefit from additional therapy.
Author List
Thalji SZ, Aldakkak M, Christians KK, Clarke CN, George B, Kamgar M, Erickson BA, Hall WA, Chisholm P, Kulkarni N, Doucette S, Evans DB, Tsai SAuthors
Phillip Chisholm MD Assistant Professor in the Medicine department at Medical College of WisconsinKathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Callisia N. Clarke MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin
Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Professor in the Medicine department at Medical College of Wisconsin
William Adrian Hall MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Mandana Kamgar MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Naveen Kulkarni MD Assistant Professor in the Radiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdenocarcinomaCA-19-9 Antigen
Humans
Neoadjuvant Therapy
Pancreatic Neoplasms
Prognosis
Retrospective Studies
