REFILE-Neoadjuvant chemoradiation improves outcome of pancreatic-cancer surgery

Reuters Health Information: REFILE-Neoadjuvant chemoradiation improves outcome of pancreatic-cancer surgery

REFILE-Neoadjuvant chemoradiation improves outcome of pancreatic-cancer surgery

Last Updated: 2018-06-04

(Para 3 now indicates that interview was conducted by phone, not by email.)

By Gene Emery

NEW YORK (Reuters Health) - Adding chemoradiation before surgery for early-stage pancreatic cancer followed by adjuvant chemotherapy boosts survival significantly, researchers have found.

The standard of care for patients with resectable pancreatic adenocarcinoma is resection followed by adjuvant chemotherapy, Dr. Geertjan Van Tienhoven of the Academic Medical Center in Amsterdam and colleagues write in an abstract presented June 4 at the American Society of Clinical Oncology's annual meeting in Chicago.

"In contrast to other cancers where pre-adjuvant treatment is common now, doctors in general and surgeons in particular were quite reluctant to do preoperative treatment and afraid of losing the benefits of surgery," Dr. Van Tienhoven told Reuters Health in a telephone interview. "That's why pancreatic cancer is lagging behind other types of cancer."

The team randomized 246 patients to receive immediate surgery followed by adjuvant chemotherapy or to receive neoadjuvant treatment as well (15 times of 2.4 Gy combined with gemcitabine 1,000 mg/m2 on days 1, 8 and 15, preceded and followed by a cycle of gemcitabine).

Disease-free survival was 9.9 months and 7.9 months with and without adding neoadjuvant treatment before surgery and adjuvant chemotherapy (P=0.023).

Although neoadjuvant therapy did not significantly boost overall survival (median, 17.1 months with neoadjuvant therapy vs. 13.7 months without; P=0.074), one reason may be that the tumor typically grows so fast that removal isn't always possible. Among patients in whom the cancer was removed successfully, median survival was 42.1 months with pre-treatment and 16.8 months without.

Treatment before surgery also seemed to make removal easier. When surgery was done, the rate of microscopically complete removal was 63% among patients who got chemotherapy and radiation first and 31% among those who did not (P<0.001).

"There are a lot of observational and epidemiological studies around" suggesting the pre-surgical treatment with radiochemotherapy is better, Dr. Van Tienhoven said. "This is the first trial that we hope and believe will show a real difference and will be the final proof for the circumstantial evidence that already exists."


2018 ASCO Annual Meeting.

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