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

Abstract

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.

Impact of time from diagnosis to chemotherapy on prognosis in advanced pancreatic cancer

“…Investigations focused on the timing of adjuvant chemotherapy in PC have produced mixed results. A meta-analysis concluded that commencing adjuvant therapy within 20 days after surgery was correlated with improved overall survival [11]. However, the ESPAC-3 study found no notable outcome difference when adjuvant chemotherapy was delayed by up to 12 weeks to allow for postoperative recovery [12].…”

Current Treatment of Potentially Resectable Pancreatic Ductal Adenocarcinoma: A Medical Oncologist’s Perspective

“…Although some data suggest that the early initiation of adjuvant chemotherapy might be associated with longer survival, 42 , 43 most data support that there is no to minimum difference in outcomes based on the time to initiate chemotherapy. 44 Data from the ESPAC-3 trial have not shown improved survival for patients starting adjuvant chemotherapy within 8 weeks of surgery (vs 8–12 weeks). 40 Additionally, multiple analyses suggest that the benefit of adjuvant chemotherapy stands even for patients who start chemotherapy after 12 weeks.…”