Neoadjuvant therapy extends survival in patients with left-sided resectable pancreatic cancer

Patients with left-sided resectable pancreatic cancer (RPC) enjoy improved overall survival (OS) with neoadjuvant therapy compared with upfront surgery, a recent study has shown.

Moreover, the benefit derived from neoadjuvant therapy is increased in patients with larger tumour size and higher serum carbohydrate antigen 19-9 (CA19-9) at diagnosis.

A total of 2,282 patients after left-sided pancreatic resection for RPC in 76 centres across 18 countries (2013‒2019) were included in this retrospective study. Of these, 290 (13 percent) received neoadjuvant therapy. The most common regimens used were (m)FOLFIRINOX (38 percent) and gemcitabine-nab-paclitaxel (22 percent).

Seventy-two percent of patients were administered adjuvant chemotherapy, mostly a single-agent regimen (74 percent), following upfront surgery.

Compared with upfront surgery, neoadjuvant therapy significantly improved OS (adjusted hazard ratio [aHR], 0.69, 95 percent confidence interval [CI], 0.58‒0.83), with an adjusted median OS of 53 vs 37 months (p=0.0003) and adjusted 5-year OS rates of 47 percent vs 35 percent (p=0.0001).

In interaction analysis, neoadjuvant therapy showed a stronger impact in patients with a larger tumour (p=0.003 for interaction) and higher serum CA19-9 (p=0.005 for interaction).

However, the effect of neoadjuvant therapy was not improved for splenic artery (p=0.43 for interaction), splenic vein (p=0.30 for interaction), retroperitoneal (p=0.84 for interaction), and multivisceral involvement (p=0.96 for interaction).

“Randomized controlled trials on neoadjuvant therapy specifically in patients with left-sided RPC are needed,” the investigators said.