Correlation of Maintenance Chemotherapy and Improved Survival in Patients with Locally Advanced Unresectable Pancreatic Head Adenocarcinoma Receiving Neoadjuvant Chemotherapy and Concurrent Chemoradiotherapy

Overview

Journal Am J Cancer Res

Specialty Oncology

Date 2024 Jun 11

PMID 38859863

Authors

Szu-Wen Tseng

Wan-Ming Chen

Ben-Chang Shia

Ming-Chih Chen

Szu-Yuan Wu

Affiliations

Soon will be listed here.

Abstract

To assess the efficacy of maintenance chemotherapy in the management of unresectable locally advanced pancreatic head adenocarcinoma (PHA) cancer after neoadjuvant chemotherapy and concurrent chemoradiation therapy (CCRT). This study, a large-scale head-to-head propensity score matching (PSM) cohort study, employed real-world data. PSM was used to evaluate the impact of maintenance chemotherapy on overall survival and cancer-specific survival in patients with unresectable locally advanced PHA who underwent neoadjuvant chemotherapy and CCRT. A total of 148 patients with locally advanced pancreatic head adenocarcinoma were included in the study after PSM. These patients were equally divided into two groups, those receiving maintenance chemotherapy and those who did not. Confounding factors were balanced between the groups. The adjusted hazard ratios for all-cause mortality and cancer-specific mortality were 0.56 (95% CI: 0.40-0.77; P = 0.0005) and 0.56 (95% CI: 0.40-0.78; P = 0.0007), respectively, in patients receiving maintenance chemotherapy compared to those who did not. Our large-scale, real-world study demonstrates that maintenance chemotherapy may enhance survival outcomes for patients with unresectable locally advanced pancreatic head adenocarcinoma who underwent neoadjuvant chemotherapy and concurrent chemoradiation therapy.

References

Zhang J, Lu C, Chen H, Wu S . Neoadjuvant Chemotherapy or Endocrine Therapy for Invasive Ductal Carcinoma of the Breast With High Hormone Receptor Positivity and Human Epidermal Growth Factor Receptor 2 Negativity. JAMA Netw Open. 2021; 4(3):e211785. PMC: 7955271. DOI: 10.1001/jamanetworkopen.2021.1785. View

Siegel R, Miller K, Fuchs H, Jemal A . Cancer statistics, 2022. CA Cancer J Clin. 2022; 72(1):7-33. DOI: 10.3322/caac.21708. View

Cicenas S, Geater S, Petrov P, Hotko Y, Hooper G, Xia F . Maintenance erlotinib versus erlotinib at disease progression in patients with advanced non-small-cell lung cancer who have not progressed following platinum-based chemotherapy (IUNO study). Lung Cancer. 2016; 102:30-37. DOI: 10.1016/j.lungcan.2016.10.007. View

Mei L, Chen H, Wei D, Fang F, Liu G, Xie H . Maintenance chemotherapy for ovarian cancer. Cochrane Database Syst Rev. 2013; (6):CD007414. PMC: 6457821. DOI: 10.1002/14651858.CD007414.pub3. View

Zinner R, Obasaju C, Spigel D, Weaver R, Beck J, Waterhouse D . PRONOUNCE: randomized, open-label, phase III study of first-line pemetrexed + carboplatin followed by maintenance pemetrexed versus paclitaxel + carboplatin + bevacizumab followed by maintenance bevacizumab in patients ith advanced nonsquamous.... J Thorac Oncol. 2014; 10(1):134-42. PMC: 4276572. DOI: 10.1097/JTO.0000000000000366. View

Li C, Chao Y, Chi K, Chan W, Teng H, Lee R . Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5-fluorouracil, a randomized controlled study. Int J Radiat Oncol Biol Phys. 2003; 57(1):98-104. DOI: 10.1016/s0360-3016(03)00435-8. View

Paz-Ares L, de Marinis F, Dediu M, Thomas M, Pujol J, Bidoli P . Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3,.... Lancet Oncol. 2012; 13(3):247-55. DOI: 10.1016/S1470-2045(12)70063-3. View

Conroy T, Paillot B, Francois E, Bugat R, Jacob J, Stein U . Irinotecan plus oxaliplatin and leucovorin-modulated fluorouracil in advanced pancreatic cancer--a Groupe Tumeurs Digestives of the Federation Nationale des Centres de Lutte Contre le Cancer study. J Clin Oncol. 2005; 23(6):1228-36. DOI: 10.1200/JCO.2005.06.050. View

Motoi F, Ishida K, Fujishima F, Ottomo S, Oikawa M, Okada T . Neoadjuvant chemotherapy with gemcitabine and S-1 for resectable and borderline pancreatic ductal adenocarcinoma: results from a prospective multi-institutional phase 2 trial. Ann Surg Oncol. 2013; 20(12):3794-801. DOI: 10.1245/s10434-013-3129-9. View

10.

Austin P . Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2010; 10(2):150-61. PMC: 3120982. DOI: 10.1002/pst.433. View

11.

Ikeda M, Ioka T, Ito Y, Yonemoto N, Nagase M, Yamao K . A multicenter phase II trial of S-1 with concurrent radiation therapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2012; 85(1):163-9. DOI: 10.1016/j.ijrobp.2012.03.059. View

12.

Petrioli R, Francini E, Roviello F, Marrelli D, Miano S, Fiaschi A . Treatment of advanced oesophagogastric cancer with FOLFOX-4 regimen followed by leucovorin/bolus and continuous infusion 5-FU as maintenance chemotherapy in patients aged ≥ 75 years with impaired performance status. J Geriatr Oncol. 2015; 6(5):380-6. DOI: 10.1016/j.jgo.2015.06.002. View

13.

Yen Y, Chang J, Lin W, Chiou J, Chang Y, Chang C . Effectiveness of esophagectomy in patients with thoracic esophageal squamous cell carcinoma receiving definitive radiotherapy or concurrent chemoradiotherapy through intensity-modulated radiation therapy techniques. Cancer. 2017; 123(11):2043-2053. DOI: 10.1002/cncr.30565. View

14.

Chang C, Tsai H, Lin W, Chang J, Hsu H, Chow J . Dose escalation intensity-modulated radiotherapy-based concurrent chemoradiotherapy is effective for advanced-stage thoracic esophageal squamous cell carcinoma. Radiother Oncol. 2017; 125(1):73-79. DOI: 10.1016/j.radonc.2017.08.025. View

15.

Blackford A, Canto M, Klein A, Hruban R, Goggins M . Recent Trends in the Incidence and Survival of Stage 1A Pancreatic Cancer: A Surveillance, Epidemiology, and End Results Analysis. J Natl Cancer Inst. 2020; 112(11):1162-1169. PMC: 7669234. DOI: 10.1093/jnci/djaa004. View

16.

Chi D, Chen B, Guo S, Bai K, Ma H, Hu Y . Oral maintenance therapy using apatinib combined with S-1/capecitabine for esophageal squamous cell carcinoma with residual disease after definitive chemoradiotherapy. Aging (Albany NY). 2021; 13(6):8408-8420. PMC: 8034932. DOI: 10.18632/aging.202652. View

17.

Dahan L, Williet N, Le Malicot K, Phelip J, Desrame J, Bouche O . Randomized Phase II Trial Evaluating Two Sequential Treatments in First Line of Metastatic Pancreatic Cancer: Results of the PANOPTIMOX-PRODIGE 35 Trial. J Clin Oncol. 2021; 39(29):3242-3250. DOI: 10.1200/JCO.20.03329. View

18.

Hsieh M, Chang W, Yu H, Lu C, Chang C, Chow J . Adjuvant radiotherapy and chemotherapy improve survival in patients with pancreatic adenocarcinoma receiving surgery: adjuvant chemotherapy alone is insufficient in the era of intensity modulation radiation therapy. Cancer Med. 2018; 7(6):2328-2338. PMC: 6010773. DOI: 10.1002/cam4.1479. View

19.

Hammel P, Vitellius C, Boisteau E, Wisniewski M, Colle E, Hilmi M . Maintenance therapies in metastatic pancreatic cancer: present and future with a focus on PARP inhibitors. Ther Adv Med Oncol. 2020; 12:1758835920937949. PMC: 7350045. DOI: 10.1177/1758835920937949. View

20.

Liu W, Liu H, Kao Y, Qin L, Lin K, Fang C . Definitive radiotherapy or surgery for early oral squamous cell carcinoma in old and very old patients: A propensity-score-matched, nationwide, population-based cohort study. Radiother Oncol. 2020; 151:214-221. DOI: 10.1016/j.radonc.2020.08.016. View