Efficacy of platinum chemotherapy agents in the adjuvant setting for adenosquamous carcinoma of the pancreas.

Abstract

Background: Pancreatic adenosquamous carcinoma (PASC) accounts for only 1-4% of all exocrine pancreatic cancers and carries a particularly poor prognosis. This retrospective study was performed to determine whether inclusion of a platinum agent as part of adjuvant therapy is associated with improved survival in patients with resected PASC. Methods:Records of all patients who underwent pancreatic resection at Johns Hopkins Hospital from 1986 to 2012 were reviewed to identify those with PASC. Multivariable Cox proportional hazards modeling was used to assess for significant associations between patient characteristics and survival.Results: In total, 62 patients (1.1%) with resected PASC were identified among 5,627 cases. Median age was 68 [interquartile range (IQR), 57-77] and 44% were female. Multivariate analysis revealed that, among all patients (n=62), the following factors were independently predictive of poor survival: lack of adjuvant therapy [hazard ratio (HR) =3.6; 95% confidence interval (CI), 1.8-7.0; P<0.001], margin-positive resection (HR =3.5; 95% CI, 1.8-6.8; P<0.001), lymph node involvement (HR =3.5; 95% CI, 1.5-8.2; P=0.004), and age (HR =1.0; 95% CI, 1.0-1.1; P=0.035). There were no significant differences between patients who did and did not receive adjuvant therapy following resection (all P>0.05). A second multivariable model included only those patients who received adjuvant therapy (n=39). Lack of inclusion of a platinum agent in the adjuvant regimen (HR =2.4; 95% CI, 1.0-5.8; P=0.040) and larger tumor diameter (HR =1.3; 95% CI, 1.0-1.6; P=0.047) were independent predictors of inferior survival.Conclusions: Addition of a platinum agent to adjuvant regimens for resected PASC may improve survival among these high-risk patients, though collaborative prospective investigation is needed.

Comparative outcomes of adenosquamous carcinoma of the pancreas: An analysis of the National Cancer Database

“…Although the study by Katz et al demonstrated a benefit of systemic chemotherapy in both non‐surgical and surgically resected patients, the authors included both ASCP and PDAC in their analysis limiting conclusions about the benefit of chemotherapy in ASCP patients alone. A single institution trial by Wild et al demonstrated a benefit of adjuvant chemotherapy in 39 patients over 26 years who received a regimen of systemic therapy. Although the authors concluded that the addition of platinum based chemotherapy to standard regimens was associated with further improved survival, the small number of patients (14 of 39 patients) receiving this regimen makes drawing conclusions difficult .…”

“…A single institution trial by Wild et al demonstrated a benefit of adjuvant chemotherapy in 39 patients over 26 years who received a regimen of systemic therapy. Although the authors concluded that the addition of platinum based chemotherapy to standard regimens was associated with further improved survival, the small number of patients (14 of 39 patients) receiving this regimen makes drawing conclusions difficult . While the use of an administrative database limits determining the specific regimen given during the course of our study, the association with improved survival in both surgical and non‐surgical patients is notable.…”

Adenosquamous carcinoma of the pancreas: Molecular characterization of 23 patients along with a literature review

“…Most case reports in the literature have used 5-fluorouracil based therapies for treatment around surgical procedures and have not examined the role of gemcitabine or more robust regimens such as FOLFIRINOX or nab-paclitaxel/ gemcitabine [49] . In a retrospective series of 62 patients identified with pancreatic adenosquamous carcinoma, 14 patients received platinum therapy in the adjuvant setting as opposed to 48 who did not [53] . The patients who received platinum therapy in the adjuvant setting had an overall median survival of 19.1 mo as opposed to 10.7 mo for those who did not (P = 0.011, hazard ratio of survival 0.48) [53] .…”

“…In a retrospective series of 62 patients identified with pancreatic adenosquamous carcinoma, 14 patients received platinum therapy in the adjuvant setting as opposed to 48 who did not [53] . The patients who received platinum therapy in the adjuvant setting had an overall median survival of 19.1 mo as opposed to 10.7 mo for those who did not (P = 0.011, hazard ratio of survival 0.48) [53] . The role of radiation therapy as an adjunct to resection of ASCP is also unclear [48,54,55] .…”

Early relapse on adjuvant gemcitabine associated with an exceptional response to 2nd line capecitabine chemotherapy in a patient with pancreatic adenosquamous carcinoma with strong intra-tumoural expression of cytidine deaminase: a case report

“…It is associated with a poor prognosis, with a median survival of 4 months (95% CI, 3-6 months) or 12 months (95% CI, 8-52 months) postresection in cases of early stage disease [2]. The use of adjuvant chemotherapy is supported by retrospective analyses [2][3][4], commonly with single agent gemcitabine or 5fluorouracil according to the evidence base for the treatment of the broader group of pancreatic exocrine malignancies [5,6] . The optimal management of progressive disease during adjuvant chemotherapy in patients with adenosquamous carcinoma is unknown.…”