Completion of Adjuvant Chemotherapy After Pancreatic Resection Linked With Improved Survival

Patient with pancreatic adenocarcinoma before (A) and during (B) surgery.

Completion of 6 cycles of adjuvant chemotherapy, rather than time of initiation, was an independent prognostic factor after resection of pancreatic adenocarcinoma, according to results taken from the phase III European Study Group for Pancreatic Cancer-3.

“There was no survival disadvantage from delaying the start of treatment for up to 12 weeks after surgery. Conversely, there was no survival advantage for starting early treatment, within 8 weeks of surgery,” wrote Juan W. Valle, MD, of the Christie Hospital NHs Foundation Trust and University of Manchester, and colleagues in the Journal of Clinical Oncology.

According to the researchers, although it was known that adjuvant chemotherapy after resection of pancreatic adenocarcinoma was known to improve survival, data were lacking on the optimal timing and duration of this treatment.

To explore this further, Valle and colleagues used data from 985 patients enrolled in the European Study Group for Pancreatic Cancer-3 who were assigned to chemotherapy. Patients received either gemcitabine (49%) or fluorouracil (51%), and 68% were able to complete all 6 cycles of treatment.

Timing of the initiation of chemotherapy did not affect overall survival outcomes. The median survival for patients starting therapy within 8 weeks of surgery was 22.6 months compared with 24.2 months for those who started between week 8 and week 12.

However, the data did show that those patients who were able to complete all 6 cycles of therapy had significantly improved survival compared with those who did not (28 months vs 14.6 months; P < .001).

The researchers found that among those patients who completed less than 6 cycles of therapy, a later chemotherapy start time was associated with improved survival.

“In routine clinical practice, though it is not possible to know in the immediate postoperative setting whether a patient will go on to complete the full course of treatment, ensuring adequate postoperative recovery is likely to maximize this chance,” the researchers wrote. “Patients who feel stronger after a slightly longer period of postoperative convalescence may be more likely to stay the full course of adjuvant chemotherapy.”

In an accompanying editorial, Emily Chan, MD, PhD, and Jordan Berlin, MD, of Vanderbilt University Medical Center, wrote that the results of the study by Valle and colleagues is a great example of the childhood lesion “slow and steady wins the race.”

“The data presented by Valle et al will help allay patient fears of losing ground, so to speak, by not starting treatment right away, before they have sufficiently recovered from surgery,” Chan and Berlin wrote. “In this long distance race, it is not who sprints fastest from the starting line, but who can keep up the pace and complete the race that will determine the winner.”

However, they also point out that this study fails to address the efficacy of initiating treatment later than 12 weeks after surgery. Moving forward, Chan and Berlin emphasized the need for continued research, ongoing collection and interrogation of tissue, and further understanding of the biology of pancreatic cancer in order to truly begin to influence the lives of patients with this disease.