Defining the optimal timing of adjuvant therapy for resected pancreatic adenocarcinoma: A statewide cancer registry analysis

Saeed, Hayder; Hnoosh, Dima; Huang, Bin; Durbin, Eric B.; McGrath, Patrick C.; DeSimone, Philip A.; Maynard, Erin; Anthony, Lowell; Dineen, Seán; Hosein, Peter J.; Tzeng, Ching‐Wei D.

doi:10.1002/jso.24314

Cited by 16 publications

(13 citation statements)

References 26 publications

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“…These 34 studies corresponded to the post-hoc analyses of randomized controlled trials and cohorts and to retrospective studies. They included a total of 141,853 patients: 134,701 in the colon cancer cohort, as shown in Table 1 [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]; 5121 in the gastric cancer cohort, as shown in Table 2 [26,27,28,29,30,31]; and 2031 in the pancreatic cancer cohort, as shown in Table 3 [32,33,34,35,36,37]. Among these studies, 22 were used for the colorectal cancer analysis and six were used for pancreatic and gastric cancer each.…”

Section: Resultsmentioning

confidence: 99%

Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis

Petrelli

Zaniboni

Ghidini

et al. 2019

Cancers

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(1) Background: The optimal timing of adjuvant chemotherapy (CT) in gastrointestinal malignancies is still a matter of debate. For colorectal cancer, it is recommended to start post-operative treatment within eight weeks. The objective of this study was to assess the clinical effects of starting adjuvant CT within or after 6–8 weeks post-surgery in colorectal, gastric, and pancreatic cancer. (2) Methods: MEDLINE, EMBASE, and the Cochrane Library were searched in December 2018. Publications comparing the outcomes of patients treated with adjuvant CT administered before (early) or after (delayed) 6–8 weeks post-surgery for colorectal, gastric, and pancreatic cancer were identified. The primary endpoint was overall survival (OS). (3) Results: Out of 8752 publications identified, 34 comparative studies assessing a total of 141,853 patients were included. Meta-analysis indicated a statistically significant increased risk of death with delayed CT (>6–8 weeks post-surgery) in colorectal cancer (hazard ratio (HR) = 1.27, 95% confidence interval (CI) 1.21–1.33; p <0.001). Similarly, for gastric cancer, delaying adjuvant CT was associated with inferior overall survival (HR = 1.2, 95% CI 1.04–1.38; p = 0.01). Conversely, the benefit of earlier CT was not evident in pancreatic cancer (HR = 1, 95% CI 1–1.01; p = 0.37). Conclusions: Starting adjuvant CT within 6–8 weeks post-surgery is associated with a significant survival benefit for colorectal and gastric cancer, but not for pancreatic cancer.

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Section: Resultsmentioning

confidence: 99%

Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis

Petrelli

Zaniboni

Ghidini

et al. 2019

Cancers

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“…Prior studies suggested no benefit to early initiation of adjuvant therapy but only compared survival between arbitrarily assigned time periods. 15,16,17,18,19…”

Section: Introductionmentioning

confidence: 99%

Association of Timing of Adjuvant Therapy With Survival in Patients With Resected Stage I to II Pancreatic Cancer

et al. 2019

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Key Points Question Is the timing of adjuvant therapy in resected pancreatic cancer associated with better survival? Findings This cohort study of 7548 patients with stage I to II pancreatic cancer in the National Cancer Database suggested improved survival when adjuvant therapy was initiated 28 to 59 days after surgery. Patients who recovered slowly from surgery still benefited from delayed adjuvant therapy initiated more than 12 weeks after the procedure compared with patients who received surgery alone. Meaning Shared decision-making between clinicians and patients is needed to individualize when to initiate adjuvant therapy based on patients’ postoperative recovery.

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“…Two additional reports from 2016 found no differences in OS when comparing those who started chemotherapy within 8 weeks of surgery and those who started treatment after the eight‐week timepoint. 14 , 15 Lee et al 17 reported that early vs late initiation of adjuvant therapy, defined as before or after 6 weeks postoperatively, did not impact OS. However, the authors also commented that patients who were able to complete therapy had a significant survival advantage.…”

Section: Discussionmentioning

confidence: 99%

“…10 Indeed, the time from a patients' operation until starting adjuvant therapy can vary widely. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 Some patients may never recover enough to receive any amount of adjuvant treatment. Alternatively, patients may not tolerate multi‐agent chemotherapy after resection and instead receive less effective single agent therapy.…”

Section: Introductionmentioning

confidence: 99%

The importance of time‐to‐adjuvant treatment on survival with pancreatic cancer: A systematic review and meta‐analysis

et al. 2021

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Background: While adjuvant chemotherapy benefits patients with pancreatic ductal adenocarcinoma (PDAC), the importance of the time to initiation of adjuvant therapy remains unclear.Aim: This study seeks to better understand whether the timing of postoperative chemotherapy initiation affects long-term outcomes in PDAC. Methods and Results: A systematic literature search was performed in Medline, Embase, and Cochrane Library in March 2020. Studies focused on the association between the timing of adjuvant therapy on long-term outcomes in resected PDAC patients were included. The impact of early and delayed therapy as defined by the respective studies was evaluated using forest plot analysis. Overall survival (OS) and disease-free survival (DFS) served as primary endpoints. Out of 3099 published articles, 10 retrospective studies met inclusion criteria. Combined, these studies included clinical data of 13 344 patients. The cut off used to define "early" and "delayed" treatment groups varied in the included studies ranging from 3 to 12 weeks. Due to this heterogeneity, a sub-group analysis of three time cut offs was performed: 3 to 5 weeks, 6 to 8 weeks, and 9 to 12 weeks. There was a significant decrease in OS and DFS when adjuvant therapy was delayed by 3 to 5 weeks after surgery (OS, pooled hazard ratio [HR] = 1.86, 95% confidence interval [CI] = 1.25-2.78; DFS, pooled HR = 1.62, 95% CI = 1.12-2.34). However, due to small sample size and limited studies in this subgroup analysis, the results may be indeterminate. There was no significant decrease in OS with delayed initiation of adjuvant therapy by 6 to 8 weeks and 9 to 12 weeks. Similarly, delay in adjuvant therapy beyond 3-5 weeks.Conclusions: There was no conclusive evidence suggesting improved survival in patients starting treatment at various time cut offs. Studies investigating the extreme ends of the time-to-treatment spectrum may prove more informative.

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Defining the optimal timing of adjuvant therapy for resected pancreatic adenocarcinoma: A statewide cancer registry analysis

Cited by 16 publications

References 26 publications

Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis

Timing of Adjuvant Chemotherapy and Survival in Colorectal, Gastric, and Pancreatic Cancer. A Systematic Review and Meta-Analysis

Association of Timing of Adjuvant Therapy With Survival in Patients With Resected Stage I to II Pancreatic Cancer

The importance of time‐to‐adjuvant treatment on survival with pancreatic cancer: A systematic review and meta‐analysis

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