Chemoradiotherapy following induction chemotherapy improves pancreatic tumor resectability
Click Here to Manage Email Alerts
Chemoradiotherapy after induction chemotherapy improved R0 resection rate; rate of circumferential resection margin-negative resection and pathologic complete response rate among patients with pancreatic cancer treated with surgery.
Among the patients in a multicenter, randomized, phase 3 trial presented at ASCO Annual Meeting, with the exception of R0 resection rate, the other parameters remain significant. "This shows that chemoradiotherapy improves the resectability of these tumors and this may translate into better long-term survival," Rainer Fietkau, MD, of the department of radiation oncology at University of Erlangen-Nuremberg, in Erlangen, Germany, said during his presentation.
Though the effect on the primary endpoint of resectability — which was evaluated by an independent surgical expert commitee — was significant, the researchers did not find a statistically significant effect on PFS or OS.
Regarding the primary endpoint, Fietkau said that "additional chemoradiotherapy improves significantly the R0 resection rate in the surgically treated group, but not all randomized patients."
The rate of R0 resection — a microscopically margin-negative resection that successfully removes all tumor particles — and pathologic complete response (pCR) rates were notably higher in patients who received both chemotherapy and chemoradiotherapy, according to the data. Of 525 patients enrolled in the study, 402 received both induction chemotherapy and FOLFIRINOX (folinic acid, 5FU, irinotecan and oxaliplatin)) and 93 received induction chemotherapy and gemcitabine. Following induction chemotherapy, 189 patients were removed due to disease progression or drug toxicity, while 336 were randomized into two groups: those who continued chemotherapy for 3 more months or those who received chemoradiotherapy.
The chemoradiotherapy arm had significantly higher R0 circumferential resection margin (CRM)-negative resection and pCR rates, according to the study. Moreover, the study showed a significant effect of additional surgery on the survival rate: no patient without surgery survived 5 years. In contrast, the 5-year survival rate of surgically treated patients was 17.5%. Patients with a R0 resection or CRM-negative resection had a high 5-year survival rate of 27% and 35%, emphasizing the necessity to achieve a R0 or CRM-negative resection with the help of pretreatment chemotherapy and chemoradiotherapy.
Fietkau said that next steps may include more precisely defining the subgroup of patients who may benefit from chemotherapy/chemoradiotherapy and surgery.
Collapse
Fietkau R, et al. Abstract 4008. Presented at: ASCO Annual Meeting; June 3-7; Chicago.
Read more about
Click Here to Manage Email Alerts