Overall survival of patients with recurrent pancreatic cancer treated with systemic therapy: a retrospective study

Abstract

Background Only a few patients with pancreatic ductal adenocarcinoma (PDAC) recurring after curative resection and peri-operative (neoadjuvant and adjuvant) therapy are included in clinical trials of metastatic PDAC. As such, there is a paucity of data to guide treatment after relapse, and patients are treated similarly to those with de novo metastatic PDAC (mPDAC). We evaluated the patterns of chemotherapy use and over-all survival (OS) in patients with recurrent PDAC (rPDAC) following curative therapy. Methods In this retrospective study, the Indiana University pancreatic cancer database was used to identify patients with PDAC who underwent curative resection and subsequently developed recurrence. Demographics, tumor and treatment characteristics were collected. Patients were broadly divided into those who received chemotherapy for rPDAC and those who did not. Patients in the former category were further subdivided into those who received single agent therapy, any standard combination therapy (5-fluorouracil/irinotecan/oxaliplatin combination or gemcitabine/nab-paclitaxel) and those who received non-standard combinations. Survival analysis was performed by the Kaplan-Meier method. Log rank tests were used to determine differences in survival between treated rPDAC patients and those not treated. Cox regression analysis was employed to evaluate factors associated with OS. Results We identified 435 patients with resected PDAC treated between 2008 and 2014. Two hundred and twenty-three patients (51.2%) were diagnosed with rPDAC. Of these, 140 patients (63%) received chemotherapy whereas 71 patients (32%) did not receive chemotherapy. The 74 patients (53%) who received any standard, approved multiagent combination regimen had a median OS of 14 months compared to 8 months for the 47 patents (34%) who received other non-standard combinations and the 19 (13%) who received single agent therapy ( P = 0.029). Multivariate cox regression analysis showed that margin negative resection, peri-operative therapy, radiotherapy and the use of any chemotherapy for rPDAC were associated with improved OS. Conclusion Our findings support the use of standard approved multi-agent therapy in rPDAC. Patients derive significant benefit from these standard combination therapies with median OS that is comparable to what is observed with treatment for de novo mPDAC. Electronic supplementary material The online version of this article (10.1186/s12885-019-5630-4) contains supplementary material, which is available to authorized users.

Are We Sure that Adjuvant Chemotherapy is the Best Approach for Resectable Pancreatic Cancer? Are We in the Era of Neoadjuvant Treatment? A Review of Current Literature

“…Subsequently, the problem of which treatment to propose after relapse of the disease will arise. Gbolahan et al [77] observed 10-month median post-relapse OS (mOS) in patients with resected pancreatic cancer who had received combination therapy or monotherapy after relapse and 3-month mOS in patients undergoing best supportive care (BSC). In particular, the 14-month OS improvement was much more evident with a standard combination therapy regimen than with a single agent or non-standard combination chemotherapy [77].…”

“…Gbolahan et al [77] observed 10-month median post-relapse OS (mOS) in patients with resected pancreatic cancer who had received combination therapy or monotherapy after relapse and 3-month mOS in patients undergoing best supportive care (BSC). In particular, the 14-month OS improvement was much more evident with a standard combination therapy regimen than with a single agent or non-standard combination chemotherapy [77]. There is a lack of studies on the use of chemotherapy in patients with resected PC who relapsed after an initial curative therapy with both neoadjuvant and adjuvant treatment, and it is not clear to what extent the first therapy may influence the efficacy and tolerability of the subsequent chemotherapy.…”

Late recurrences of pancreatic cancer in patients with long-term survival after pancreaticoduodenectomy

“…Our data present significant higher post-recurrence survival rates compared to current survival data in the literature. Median survival period after detection of TR was 33 months compared to a median of 7 months reported in the literature due to delayed diagnosis of TR (26). In cases of a low overall performance status, patients receive best supportive care only.…”

“…Daamen et al report a 35% treatment rate compared to a best supportive care rate of 65%: main causes were the patient's wish (40%) and poor overall performance status (30%) (15). However, another study by Gbolahan et al investigating data of 435 patients showed a 63% chemotherapy rate and a 32% best supportive care rate (26).…”

“…Relevant risk factors for local TR are a negative resection margin as well as existence and extension of lymphogenous metastasis (20,22,27,28). Further relevant factors affecting the overall survival were perioperative treatment by chemotherapy or radiotherapy (26).…”