Overall survival of patients with recurrent pancreatic cancer treated with systemic therapy: A retrospective study

Olumide B. Gbolahan, Yan Tong, Amikar Sehdev, Bert O'neil, Safi Shahda

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Only a few patients with pancreatic ductal adenocarcinoma (PDAC) recurring after curative resection and peri-operative (neoadjuvant and adjuvant) therapy are included in clinical trials of metastatic PDAC. As such, there is a paucity of data to guide treatment after relapse, and patients are treated similarly to those with de novo metastatic PDAC (mPDAC). We evaluated the patterns of chemotherapy use and over-all survival (OS) in patients with recurrent PDAC (rPDAC) following curative therapy. Methods: In this retrospective study, the Indiana University pancreatic cancer database was used to identify patients with PDAC who underwent curative resection and subsequently developed recurrence. Demographics, tumor and treatment characteristics were collected. Patients were broadly divided into those who received chemotherapy for rPDAC and those who did not. Patients in the former category were further subdivided into those who received single agent therapy, any standard combination therapy (5-fluorouracil/irinotecan/oxaliplatin combination or gemcitabine/nab-paclitaxel) and those who received non-standard combinations. Survival analysis was performed by the Kaplan-Meier method. Log rank tests were used to determine differences in survival between treated rPDAC patients and those not treated. Cox regression analysis was employed to evaluate factors associated with OS. Results: We identified 435 patients with resected PDAC treated between 2008 and 2014. Two hundred and twenty-three patients (51.2%) were diagnosed with rPDAC. Of these, 140 patients (63%) received chemotherapy whereas 71 patients (32%) did not receive chemotherapy. The 74 patients (53%) who received any standard, approved multiagent combination regimen had a median OS of 14 months compared to 8 months for the 47 patents (34%) who received other non-standard combinations and the 19 (13%) who received single agent therapy (P = 0.029). Multivariate cox regression analysis showed that margin negative resection, peri-operative therapy, radiotherapy and the use of any chemotherapy for rPDAC were associated with improved OS. Conclusion: Our findings support the use of standard approved multi-agent therapy in rPDAC. Patients derive significant benefit from these standard combination therapies with median OS that is comparable to what is observed with treatment for de novo mPDAC.

Original languageEnglish (US)
Article number468
JournalBMC Cancer
Volume19
Issue number1
DOIs
StatePublished - May 17 2019

Fingerprint

Pancreatic Neoplasms
Retrospective Studies
Survival
Adenocarcinoma
Therapeutics
Drug Therapy
irinotecan
oxaliplatin
gemcitabine
Regression Analysis
Recurrence
Neoadjuvant Therapy
Patents
Survival Analysis
Fluorouracil
Radiotherapy
Demography
Clinical Trials
Databases

Keywords

  • Combination chemotherapy
  • FOLFIRINOX
  • Gemcitabine-nab paclitaxel
  • Metastatic pancreatic cancer
  • Recurrent pancreatic cancer
  • Recurrent pancreatic ductal adenocarcinoma

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research

Cite this

Overall survival of patients with recurrent pancreatic cancer treated with systemic therapy : A retrospective study. / Gbolahan, Olumide B.; Tong, Yan; Sehdev, Amikar; O'neil, Bert; Shahda, Safi.

In: BMC Cancer, Vol. 19, No. 1, 468, 17.05.2019.

Research output: Contribution to journalArticle

Gbolahan, Olumide B. ; Tong, Yan ; Sehdev, Amikar ; O'neil, Bert ; Shahda, Safi. / Overall survival of patients with recurrent pancreatic cancer treated with systemic therapy : A retrospective study. In: BMC Cancer. 2019 ; Vol. 19, No. 1.
@article{dd092adc1c014d1196ed4ac08bf5e587,
title = "Overall survival of patients with recurrent pancreatic cancer treated with systemic therapy: A retrospective study",
abstract = "Background: Only a few patients with pancreatic ductal adenocarcinoma (PDAC) recurring after curative resection and peri-operative (neoadjuvant and adjuvant) therapy are included in clinical trials of metastatic PDAC. As such, there is a paucity of data to guide treatment after relapse, and patients are treated similarly to those with de novo metastatic PDAC (mPDAC). We evaluated the patterns of chemotherapy use and over-all survival (OS) in patients with recurrent PDAC (rPDAC) following curative therapy. Methods: In this retrospective study, the Indiana University pancreatic cancer database was used to identify patients with PDAC who underwent curative resection and subsequently developed recurrence. Demographics, tumor and treatment characteristics were collected. Patients were broadly divided into those who received chemotherapy for rPDAC and those who did not. Patients in the former category were further subdivided into those who received single agent therapy, any standard combination therapy (5-fluorouracil/irinotecan/oxaliplatin combination or gemcitabine/nab-paclitaxel) and those who received non-standard combinations. Survival analysis was performed by the Kaplan-Meier method. Log rank tests were used to determine differences in survival between treated rPDAC patients and those not treated. Cox regression analysis was employed to evaluate factors associated with OS. Results: We identified 435 patients with resected PDAC treated between 2008 and 2014. Two hundred and twenty-three patients (51.2{\%}) were diagnosed with rPDAC. Of these, 140 patients (63{\%}) received chemotherapy whereas 71 patients (32{\%}) did not receive chemotherapy. The 74 patients (53{\%}) who received any standard, approved multiagent combination regimen had a median OS of 14 months compared to 8 months for the 47 patents (34{\%}) who received other non-standard combinations and the 19 (13{\%}) who received single agent therapy (P = 0.029). Multivariate cox regression analysis showed that margin negative resection, peri-operative therapy, radiotherapy and the use of any chemotherapy for rPDAC were associated with improved OS. Conclusion: Our findings support the use of standard approved multi-agent therapy in rPDAC. Patients derive significant benefit from these standard combination therapies with median OS that is comparable to what is observed with treatment for de novo mPDAC.",
keywords = "Combination chemotherapy, FOLFIRINOX, Gemcitabine-nab paclitaxel, Metastatic pancreatic cancer, Recurrent pancreatic cancer, Recurrent pancreatic ductal adenocarcinoma",
author = "Gbolahan, {Olumide B.} and Yan Tong and Amikar Sehdev and Bert O'neil and Safi Shahda",
year = "2019",
month = "5",
day = "17",
doi = "10.1186/s12885-019-5630-4",
language = "English (US)",
volume = "19",
journal = "BMC Cancer",
issn = "1471-2407",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Overall survival of patients with recurrent pancreatic cancer treated with systemic therapy

T2 - A retrospective study

AU - Gbolahan, Olumide B.

AU - Tong, Yan

AU - Sehdev, Amikar

AU - O'neil, Bert

AU - Shahda, Safi

PY - 2019/5/17

Y1 - 2019/5/17

N2 - Background: Only a few patients with pancreatic ductal adenocarcinoma (PDAC) recurring after curative resection and peri-operative (neoadjuvant and adjuvant) therapy are included in clinical trials of metastatic PDAC. As such, there is a paucity of data to guide treatment after relapse, and patients are treated similarly to those with de novo metastatic PDAC (mPDAC). We evaluated the patterns of chemotherapy use and over-all survival (OS) in patients with recurrent PDAC (rPDAC) following curative therapy. Methods: In this retrospective study, the Indiana University pancreatic cancer database was used to identify patients with PDAC who underwent curative resection and subsequently developed recurrence. Demographics, tumor and treatment characteristics were collected. Patients were broadly divided into those who received chemotherapy for rPDAC and those who did not. Patients in the former category were further subdivided into those who received single agent therapy, any standard combination therapy (5-fluorouracil/irinotecan/oxaliplatin combination or gemcitabine/nab-paclitaxel) and those who received non-standard combinations. Survival analysis was performed by the Kaplan-Meier method. Log rank tests were used to determine differences in survival between treated rPDAC patients and those not treated. Cox regression analysis was employed to evaluate factors associated with OS. Results: We identified 435 patients with resected PDAC treated between 2008 and 2014. Two hundred and twenty-three patients (51.2%) were diagnosed with rPDAC. Of these, 140 patients (63%) received chemotherapy whereas 71 patients (32%) did not receive chemotherapy. The 74 patients (53%) who received any standard, approved multiagent combination regimen had a median OS of 14 months compared to 8 months for the 47 patents (34%) who received other non-standard combinations and the 19 (13%) who received single agent therapy (P = 0.029). Multivariate cox regression analysis showed that margin negative resection, peri-operative therapy, radiotherapy and the use of any chemotherapy for rPDAC were associated with improved OS. Conclusion: Our findings support the use of standard approved multi-agent therapy in rPDAC. Patients derive significant benefit from these standard combination therapies with median OS that is comparable to what is observed with treatment for de novo mPDAC.

AB - Background: Only a few patients with pancreatic ductal adenocarcinoma (PDAC) recurring after curative resection and peri-operative (neoadjuvant and adjuvant) therapy are included in clinical trials of metastatic PDAC. As such, there is a paucity of data to guide treatment after relapse, and patients are treated similarly to those with de novo metastatic PDAC (mPDAC). We evaluated the patterns of chemotherapy use and over-all survival (OS) in patients with recurrent PDAC (rPDAC) following curative therapy. Methods: In this retrospective study, the Indiana University pancreatic cancer database was used to identify patients with PDAC who underwent curative resection and subsequently developed recurrence. Demographics, tumor and treatment characteristics were collected. Patients were broadly divided into those who received chemotherapy for rPDAC and those who did not. Patients in the former category were further subdivided into those who received single agent therapy, any standard combination therapy (5-fluorouracil/irinotecan/oxaliplatin combination or gemcitabine/nab-paclitaxel) and those who received non-standard combinations. Survival analysis was performed by the Kaplan-Meier method. Log rank tests were used to determine differences in survival between treated rPDAC patients and those not treated. Cox regression analysis was employed to evaluate factors associated with OS. Results: We identified 435 patients with resected PDAC treated between 2008 and 2014. Two hundred and twenty-three patients (51.2%) were diagnosed with rPDAC. Of these, 140 patients (63%) received chemotherapy whereas 71 patients (32%) did not receive chemotherapy. The 74 patients (53%) who received any standard, approved multiagent combination regimen had a median OS of 14 months compared to 8 months for the 47 patents (34%) who received other non-standard combinations and the 19 (13%) who received single agent therapy (P = 0.029). Multivariate cox regression analysis showed that margin negative resection, peri-operative therapy, radiotherapy and the use of any chemotherapy for rPDAC were associated with improved OS. Conclusion: Our findings support the use of standard approved multi-agent therapy in rPDAC. Patients derive significant benefit from these standard combination therapies with median OS that is comparable to what is observed with treatment for de novo mPDAC.

KW - Combination chemotherapy

KW - FOLFIRINOX

KW - Gemcitabine-nab paclitaxel

KW - Metastatic pancreatic cancer

KW - Recurrent pancreatic cancer

KW - Recurrent pancreatic ductal adenocarcinoma

UR - http://www.scopus.com/inward/record.url?scp=85065924341&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065924341&partnerID=8YFLogxK

U2 - 10.1186/s12885-019-5630-4

DO - 10.1186/s12885-019-5630-4

M3 - Article

C2 - 31101022

AN - SCOPUS:85065924341

VL - 19

JO - BMC Cancer

JF - BMC Cancer

SN - 1471-2407

IS - 1

M1 - 468

ER -