HPB
CME
Roberto J. Vidri, MD, MPH (he/him/his)
Fellow
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States
Disclosure(s): No financial relationships to disclose
Roberto J. Vidri, MD, MPH (he/him/his)
Fellow
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States
Disclosure(s): No financial relationships to disclose
Patrick R. Varley, MD, MS
Assistant Professor
Division of Surgical Oncology, Department of Surgery, University of Wisconsin–Madison, United States
Disclosure information not submitted.
Sean M. Ronnekleiv-Kelly, MD
Assistant Professor
University of Wisconsin School of Medicine and Public Health, United States
Disclosure information not submitted.
Kelly J. Kaitlyn, MD
Associate Professor
Department of Surgery, University of Wisconsin, United States
Disclosure information not submitted.
Gregory C. Wilson, MD
Assistant Professor
University of Cincinnati College of Medicine, Department of Surgery, United States
Disclosure information not submitted.
Syed Ahmad
Disclosure information not submitted.
Rebecca A. Snyder, MD, MPH (she/her/hers)
Associate Professor of Surgery
UT MD Anderson Cancer Center
Houston, Texas, United States
Disclosure information not submitted.
Alexander A. Parikh, MD, MPH, FACS, FSSO (he/him/his)
Professor of Surgery
UT Health San Antonio MD Anderson
San Antonio, Texas, United States
Disclosure(s): No financial relationships to disclose
Chet Hammill, MD, MCR
Washington University School of Medicine
St. Louis, MO
Disclosure information not submitted.
.jpg "Hong Jin Kim, MD photo")
Hong Jin Kim, MD
Professor and Chief, Division of Surgical Oncology and Endocrine Surgery
University of North Carolina at Chapel Hill
Chapel Hill, NC, United States
Disclosure information not submitted.
Michael T. LeCompte, MD
Assistant Professor
University of North Carolina School of Medicine, United States
Disclosure information not submitted.
David A. Kooby, MD
Professor of Surgey
Emory University School of Medicine, Division of Surgical Oncology, Winship Cancer Institute, United States
Disclosure information not submitted.
Mihir M. Shah, MD (he/him/his)
Assistant Professor of Surgery
Emory University Winship Cancer Institute, United States
Disclosure information not submitted.
Shishir K. Maithel, MD
Professor of Surgery
Emory
Atlanta, GA, United States
Disclosure information not submitted.
Nipun B. Merchant, MD
Professor of Surgery
University of Miami Miller School of Medicine, United States
Disclosure information not submitted.
Jashodeep Datta, MD
Assistant Professor
University of Miami, United States
Disclosure information not submitted.
.jpg "Syed Nabeel Zafar, MD, MPH photo")
Syed Nabeel Zafar, MD, MPH
Assistant Professor of Surgery
University of Wisconsin-Madison
Madison, Wisconsin, United States
Disclosure(s): No financial relationships to disclose
Sharon Weber, MD (she/her/hers)
Professor of Surgery
UW Health/UW Madison
Madison, Wisconsin, United States
Disclosure(s): No financial relationships to disclose
Daniel E. Abbott, MD
Professor
Division of Surgical Oncology, Department of Surgery, University of Wisconsin–Madison, United States
Disclosure information not submitted.
The optimal duration of systemic therapy for patients with pancreas adenocarcinoma (PDAC), receiving neoadjuvant (NAT) with or without additional adjuvant chemotherapy (AT), is unknown. We sought to determine whether any threshold for duration of total chemotherapy (TC) was associated with improved recurrence-free (RFS) or overall (OS) following pancreatectomy.
Methods:
We conducted a retrospective review of patients undergoing pancreatectomy after NAT at seven academic, high-volume centers between 2009-2020. TC was defined as the total number of months (mos) patients received either NAT or NAT plus AT. OS was calculated from date of diagnosis and RFS from date of surgery. Iterative multilevel survival models, accounting for hospital clustering, examined the association between duration/regimen of chemotherapy received and survival.
Results:
502 patients with resectable (25%), borderline (53%), and locally advanced (22%) PDAC received NAT with or without AT (69% FOLFIRINOX and 31% Gem/Abraxane); median TC duration was 4.4 mos - 43% received only NAT (median 3.1 mos); 57% also received AT (median 2.5 mos). When compared to patients who received ≥6 mos of TC (median 7.7 mos), patients receiving < 6 mos (median 3.5 mos) had similar RFS (median 9.2 vs 8.8 mos; HR 1.2, p=0.13) but decreased OS (median 28.5 vs 32.0 mos; HR 1.3, p< 0.01). There was no difference in OS when comparing those patients who received FOLFIRINOX versus Gem/Abraxane (median 30.2 vs 29.1 mos; HR 1.26, p=0.21) or those that received only NAT versus NAT + AT (HR 0.83, p=0.52). The neoadjuvant chemotherapy regimen was switched in 4.8% of patients. These patients received a similar duration of TC compared to those who did not switch (median 4.2 vs 5.4 mos) and demonstrated similar median RFS (16.5 vs 8.9 mos; HR 0.61, p=0.29) and OS (37.3 vs 29.5 mos; HR 1.18, p=0.66).
Conclusions:
In this multi-institutional cohort of patients with resected PDAC who received NAT or NAT + AT, receipt of fewer than 6 month of total chemotherapy was associated with decreased overall survival, regardless of timing and chemotherapy regimen administered.