The current standard of care for patients with resectable pancreatic cancer is immediate surgery (i.e., upfront surgery) followed by adjuvant chemotherapy, as randomized trials investigating the value of neoadjuvant therapy have not universally shown a benefit in overall survival. However, only about a quarter of patients included in these trials had a tumor located in the pancreatic body or tail (i.e., left-sided), leaving little room for meaningful sub-analyses. Particularly these patients might benefit from neoadjuvant therapy, as these tumors are typically diagnosed later than right-sided tumors because of limited symptoms, which increases the risk on micro-metastatic disease. However, even observational evidence on the value of neoadjuvant therapy for left-sided resectable pancreatic cancer is sparse. Therefore, the present international observational study aimed to investigate the potential survival benefit of neoadjuvant therapy over upfront surgery in patients with left-sided resectable pancreatic cancer, thereby investigating different Anatomical, Biological, and Conditional (A-B-C) characteristics as potential indications for neoadjuvant therapy.
This international observational study including 2282 patients – from 76 centers from Europe, United States, Asia, and Oceania – who underwent resection of left-sided resectable pancreatic cancer, demonstrated that neoadjuvant therapy was independently associated with prolonged overall survival, including an adjusted 5-year overall survival rate of 47% after neoadjuvant therapy and 35% after upfront surgery. The interaction analysis to assess treatment effects across sub-groups showed that the effect of neoadjuvant therapy was stronger in patients with a larger tumor on imaging and in patients with a higher tumor marker CA19-9 at time of diagnosis. In contrast, the effect of neoadjuvant therapy was not enhanced in case of splenic artery, splenic vein, retroperitoneal, and multivisceral involvement. Randomized controlled trials are needed to give a definite answer on the value of neoadjuvant therapy compared to upfront surgery in patients with left-sided resectable pancreatic cancer.
Find the full publication here: The impact of neoadjuvant therapy in patients with left-sided resectable pancreatic cancer: an international multicenter study - Annals of Oncology
Researchers involved
People involved (the Amsterdam UMC / CCA authors are marked in bold):
Rangelova E, Stoop TF, van Ramshorst TME, Ali M, van Bodegraven EA, Javed AA, Hashimoto D, Steyerberg E, Banerjee A, Jain A, Sauvanet A, Serrablo A, Giani A, Giardino A, Zerbi A, Arshad A, Wijma AG, Coratti A, Zironda A, Socratous A, Rojas A, Halimi A, Ejaz A, Oba A, Patel BY, Björnsson B, Reames BN, Tingstedt B, Goh BKP, Payá-Llorente C, Del Pozo CD, González-Abós C, Medin C, van Eijck CHJ, de Ponthaud C, Takishita C, Schwabl C, Månsson C, Ricci C, Thiels CA, Douchi D, Hughes DL, Kilburn D, Flanking D, Kleive D, Silva DS, Edil BH, Pando E, Moltzer E, Kauffman EF, Warren E, Bozkurt E, Sparrelid E, Thoma E, Verkolf E, Ausania F, Giannone F, Hüttner FJ, Burdio F, Souche FR, Berrevoet F, Daams F, Motoi F, Saliba G, Kazemier G, Roeyen G, Nappo G, Butturini G, Ferrari G, Kito Fusai G, Honda G, Sergeant G, Karteszi H, Takami H, Suto H, Matsumoto I, Mora-Oliver I, Frigerio I, Fabre JM, Chen J, Sham JG, Davide J, Urdzik J, de Martino J, Nielsen K, Okano K, Kamei K, Okada K, Tanaka K, Labori KJ, Goodsell KE, Alberici L, Webber L, Kirkov L, de Franco L, Miyashita M, Maglione M, Gramellini M, Ramera M, Amaral MJ, Ramaekers M, Truty MJ, van Dam MA, Stommel MWJ, Petrikowski M, Imamura M, Hayashi M, D'Hondt M, Brunner M, Hogg ME, Zhang C, Suárez-Muñoz MÁ, Luyer MD, Unno M, Mizuma M, Janot M, Sahakyan MA, Jamieson NB, Busch OR, Bilge O, Belyaev O, Franklin O, Sánchez-Velázquez P, Pessaux P, Holka PS, Ghorbani P, Casadei R, Sartoris R, Schulick RD, Grützmann R, Sutcliffe R, Mata R, Patel RB, Takahashi R, Rodriguez Franco S, Cabús SS, Hirano S, Gaujoux S, Festen S, Kozono S, Maithel SK, Chai SM, Yamaki S, van Laarhoven S, Mieog JSD, Murakami T, Codjia T, Sumiyoshi T, Karsten TM, Nakamura T, Sugawara T, Boggi U, Hartman V, de Meijer VE, Bartholomä W, Kwon W, Koh YX, Cho Y, Takeyama Y, Inoue Y, Nagakawa Y, Kawamoto Y, Ome Y, Soonawalla Z, Uemura K, Wolfgang CL, Jang JY, Padbury R, Satoi S, Messersmith W, Wilmink JW, Abu Hilal M, Besselink MG, Del Chiaro M.