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Adjuvant Therapy Performed at High-Volume Center Improved OS in Pancreatic Cancer
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SAN FRANCISCO — Among patients with resected pancreatic cancer, overall survival was significantly better when adjuvant therapy was performed at a high-volume center rather than by a community oncologist, according to data presented at the Gastrointestinal Cancers Symposium.
“It’s increasingly recognized that surgery alone may be necessary but is usually not sufficient for long-term survival, so in contrast to what we know about volume outcomes in surgery … the impact of adjuvant therapy in a high-volume setting has not been studied,” Margaret T. Mandelson, PhD, MPH, from Virginia Mason Medical Center in Seattle, said during her presentation. “The aim of this project was to investigate whether volume was related to outcome in patients recommended for adjuvant therapy following successful resection of pancreatic cancer.”
Mandelson and her colleague, Vincent J. Picozzi, MD, identified 245 patients in their hospital’s cancer registry who were diagnosed with pancreatic cancer between 2003 and 2014 and underwent primary resection at the high-volume Virginia Mason Medical Center. Patients who received neoadjuvant therapy, had synchronous cancer, died or were lost to follow-up or had progression of disease within 3 months, or had contraindications to or refused adjuvant therapy were excluded.
Overall, 57% of patients received adjuvant therapy at Virginia Mason (n = 139) while 43% were treated by a community oncologist. Both groups had comparable tumor stage and size, nodal status, resection margins and average distance travelled to Virginia Mason for surgery. However, those treated by a community oncologist were significantly older (mean age, 68.2 vs. 63.1 years; P < .01).
Detailed information was only available for Virginia Mason patients, 96% of whom started chemotherapy (81% multi-agent chemotherapy; 53% chemoradiation).
“When we compared the survival in these two groups of patients we saw quite a difference,” Mandelson said.
Median OS was 36 months overall but significantly higher in the high-volume center group (44 vs. 28 months; P < .01). Five-year OS was 33% overall, but also significantly higher in the high-volume center group (38.6% vs. 24.8%; P < .01). Findings were comparable after adjusting for age, distance traveled and tumor characteristics.
“These findings are quite provocative,” Mandelson said. “In our study the high volume center and community cancer patients differed only with respect to age in the patient characteristics that we assessed. We saw both a superior median survival and 5-year OS in these patients. Our study does lend some support to the concept of using high-volume centers for all therapy components for pancreatic cancer that’s treated with curative intent, and ongoing investigation of patterns of care and volume impact in medical oncology certainly warrants additional investigation.” – by Adam Leitenberger
Reference:
Mandelson MT, Picozzi VJ. Abstract 191. Presented at: Gastrointestinal Cancers Symposium; Jan. 21-23, 2016; San Francisco.
Disclosure: Mandelson reports no relevant financial disclosures. Picozzi reports stock and ownership interests in AbbVie, Amgen and Johnson & Johnson; honoraria from Celgene; consulting or advisory roles for Halozyme and Taiho Pharmaceutical; and research funding from Aduro Biotech, Clovis Oncology, FibroGen, Immunomedics, Incyte, OncoMed and Theranostics Health.