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Ablative therapies show promise for advanced pancreatic cancer
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The addition of irreversible electroporation to conventional chemotherapy and radiation therapy appears to improve survival outcomes in patients with locally advanced pancreatic adenocarcinoma, according to the results of a registry study.
“Currently, patients with locally advanced pancreatic cancer who are treated with the standard of care experience very poor survival outcomes,” Robert C.G. Martin II, MD, PhD, FACS, director of surgical oncology at University of Louisville, told HemOnc Today. “We felt that augmenting the standard of care could potentially accentuate those results and improve OS.”
Clinicians have increasingly used ablative therapies in the treatment of locally advanced pancreatic cancer, according to Martin. Irreversible electroporation (IRE) is an energy delivery system that ablates tumors by inducing irreversible membrane destruction of cells.
Martin and colleagues sought to determine the efficacy of treating patients with locally advanced pancreatic cancer with IRE as part of a multimodal treatment plan.
The study included data from 200 patients (median age, 62 years; range, 27-88) with radiographic stage III locally advanced pancreatic cancer from six treatment sites throughout the U.S. Patients underwent IRE alone (n = 150) or pancreatic resection plus IRE for margin enhancement (n = 50).
All patients underwent induction chemotherapy per institutional protocol. Further, 52% underwent chemoradiation therapy for a median of 6 months (range, 5-13) prior to IRE.
Median follow-up was 29 months.
IRE was successfully performed in all patients. Thirty-seven percent of patients (IRE alone, n = 54; IRE plus resection, n = 20) experienced complications, the most common of which were gastrointestinal complications (IRE alone, n = 38; IRE plus resection, n = 8). Three deaths — all in the IRE alone cohort — occurred 3 to 90 days following IRE.
Three patients — also all in the IRE alone cohort — experienced IRE failure at 3 months. Further, six patients had local recurrence at the ablation site after IRE success.
Fifty-eight patients experienced recurrence, and the most common site of recurrence was the liver. Median PFS was 12.4 months (range, 4.4-38.9) and distant PFS was 16.8 months (range, 1.3-55).
The entire study cohort had a median OS of 24.9 months (range, 12.4-85). Patients who underwent IRE alone achieved a median OS of 23.2 months (range, 4.9-76.1) and patients who underwent IRE plus resection achieved a median OS of 28.3 months (range, 9.2-85). From the day of treatment, patients who underwent resection achieved as median OS of 23 months (range, 8.3-36.3) and patients who underwent IRE alone achieved a median OS of 18 months (range, 4.9-55.4).
The researchers acknowledged the potential for selection bias and the small number of treatment sites included as study limitations.
“We hope that these initial results will raise awareness among both physicians and patients to consider this therapy as part of their treatment algorithm,” Martin said. “We are planning to move forward with clinical trials to utilize IRE for enhanced drug delivery among patients with locally advanced pancreatic cancer.” – by Cameron Kelsall
For more information:
Robert C.G. Martin, II, MD, PhD, FACS, can be reached at University of Louisville, 315 East Broadway, Room 313, Louisville, KY 40202; email: robert.martin@louisville.edu.
Disclosure: Martin and one other researcher report consultant roles with Angiodynamics. The other researchers report no relevant financial disclosures.
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