07 Mar Adjuvant Chemotherapy Improves Survival After Pancreatic Cancer Resection
MedicalResearch.com Interview with:
Dr. Alexander Parikh
Alexander A. Parikh, M.D., M.P.H.
Associate Professor of Surgery
Director of Hepatobiliary, Pancreatic and GI Surgical Oncology
Director, Vanderbilt Pancreas Center
Vanderbilt University Medical Center
Nashville, TN
MedicalResearch.com: What is the background for this study?
Dr. Parikh: Although adjuvant chemotherapy has been proven to increase survival after successful resection of pancreatic cancer and has become the standard of care worldwide, the use of adjuvant chemoradiation is more controversial. The vast majority of randomized trials have failed to show a significant improvement in survival with the use of chemoradiation after pancreatic cancer resection. Furthermore, our own report from the multi-institutional Central Pancreatic Consortium (CPC) published several years ago failed to show a benefit in the use of chemoradiation except in high-risk groups such as lymph node positive disease.
The purpose of the current study was to investigate the patterns of recurrence with the use of adjuvant chemotherapy or chemoradiation in hopes of explaining some of these differences. It was our hypothesis that systemic chemotherapy would prevent distant recurrence (and perhaps local) while chemoradiation would only prevent local recurrence and thereby have less impact on overall survival.
MedicalResearch.com: What are the main findings?
Dr. Parikh: The main findings demonstrated that adjuvant chemotherapy led to an improvement in both local and distant recurrence with a corresponding improvement in overall survival while chemoradiation only led to an improvement in local recurrence but not distant nor overall survival.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Parikh: All patients with resected pancreatic cancer should receive adjuvant chemotherapy, which consists of 6 months of treatment following resection. The role of adjuvant chemoradiation is still unproven and should not be given at the expense of full dose chemotherapy. Ideally, the use of adjuvant chemoradiation should only be given as part of a clinical trial.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Parikh: Randomized trials that showed an improvement for the use of adjuvant chemotherapy have used a full 6 months of systemic chemotherapy following resection. Traditionally, adjuvant chemoradiation, however, is given as a sandwich regimen in between courses of chemotherapy. The total amount of full dose chemotherapy, therefore, is usually only 4 months. This reduced amount of chemotherapy may be one of the reasons that the use of adjuvant chemoradiation has not shown a survival benefit. It is therefore our recommendations that any future randomized trials utilizing chemoradiation should include a full 6 months of systemic chemotherapy and not less.
The ongoing cooperative group randomized clinical trial RTOG 0848 is randomizing patients to a full course of adjuvant chemotherapy (Gemcitabine) plus or minus adjuvant chemoradiation. We encourage participation in this trial and it is our hope that the results will finally conclusively answer the role of chemoradiation in the treatment of resected pancreatic cancer.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
J Am Coll Surg. 2016 Feb 13. pii: S1072-7515(16)00015-6. doi: 10.1016/j.jamcollsurg.2015.12.031. [Epub ahead of print]
Adjuvant Therapy in Pancreas Cancer: Does It Influence Patterns of Recurrence?
Parikh AA1, Maiga A2, Bentrem D3, Squires MH 3rd4, Kooby DA4, Maithel SK4, Weber SM5, Cho CS5, Katz M6, Martin RC7, Scoggins CR7, Sutton J8, Ahmad SA8, Abbott DE8, Carr J9, Kim HJ9, Yakoub D10, Idrees K2, Merchant N10.
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Alexander A. Parikh, M.D., M.P.H. (2016). Adjuvant Chemotherapy Improves Survival After Pancreatic Cancer Resection
Last Updated on March 7, 2016 by Marie Benz MD FAAD