Association of Timing of Adjuvant Therapy With Survival in Patients With Resected Stage I to II Pancreatic Cancer

Jun, Sung; Oladeru, Oluwadamilola T.; Miccio, Joseph A.; Iovoli, Austin J.; Hermann, Gregory M.; Singh, Anurag

doi:10.1001/jamanetworkopen.2019.9126

Cited by 60 publications

(39 citation statements)

References 52 publications

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“…We retrospectively analyzed the duration of adjuvant treatment grouped into three categories (without or <2 months, 2-4 months, and 4-6 months) and found that a longer duration conferred benefit to RPC patients, demonstrating the adequate adjuvant course for the high recurrence risk population, and may present a potentially promising treatment option of consolidation therapy in pancreatic cancer patients. Most of the patients in our study initiated adjuvant therapy within eight weeks postoperatively according to the current consensus (50), and previous results showed that patients still benefit from adjuvant therapy started more than 12 weeks after surgical resection (51). From 2013, eligible patients were continuously recruited, and our study may present as one of the largest sample sizes published in pancreatic cancer to date.…”

Section: Discussionmentioning

confidence: 94%

A Novel Validated Recurrence Stratification System Based on 18F-FDG PET/CT Radiomics to Guide Surveillance After Resection of Pancreatic Cancer

Wei

Song

et al. 2021

Front. Oncol.

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objectiveDespite the heterogeneous biology of pancreatic cancer, similar surveillance schemas have been used. Identifying the high recurrence risk population and conducting prompt intervention may improve prognosis and prolong overall survival.MethodsOne hundred fifty-six resectable pancreatic cancer patients who had undergone 18F-FDG PET/CT from January 2013 to December 2018 were retrospectively reviewed. The patients were categorized into a training cohort (n = 109) and a validation cohort (n = 47). LIFEx software was used to extract radiomic features from PET/CT. The risk stratification system was based on predictive factors for recurrence, and the index of prediction accuracy was used to reflect both the discrimination and calibration.ResultsOverall, seven risk factors comprising the rad-score and clinical variables that were significantly correlated with relapse were incorporated into the final risk stratification system. The 1-year recurrence-free survival differed significantly among the low-, intermediate-, and high-risk groups (85.5, 24.0, and 9.1%, respectively; p < 0.0001). The C-index of the risk stratification system in the development cohort was 0.890 (95% CI, 0.835–0.945).ConclusionThe 18F-FDG PET/CT-based radiomic features and clinicopathological factors demonstrated good performance in predicting recurrence after pancreatectomy in pancreatic cancer patients, providing a strong recommendation for an adequate adjuvant therapy course in all patients. The high-risk recurrence population should proceed with closer follow-up in a clinical setting.

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Section: Discussionmentioning

confidence: 94%

A Novel Validated Recurrence Stratification System Based on 18F-FDG PET/CT Radiomics to Guide Surveillance After Resection of Pancreatic Cancer

Wei

Song

et al. 2021

Front. Oncol.

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“…This trend is concerning as research suggests that the timing of chemotherapy administration affects pancreatic cancer outcomes. 6 Contributing factors likely include the temporary freeze of clinical trial enrollment at our large academic center during the pandemic and subsequent patient preference to undergo standard of care chemotherapy options closer to home and in the community.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the impact of the COVID‐19 pandemic on gastrointestinal cancer care delivery

Perkons¹,

Kim²,

Boedec³

et al. 2021

Cancer Reports

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Background and Aim This study quantifies how changes in healthcare utilization and delivery during the first months of the COVID‐19 pandemic have altered the presentation, treatment, and management of patients with gastrointestinal (GI) malignancies within an academic health system. Methods and results Patients diagnosed with a GI malignancy (ICD10: C15‐C26) who received medical care within the health system during the observation period (first 44 weeks of 2019 and 2020) were identified for a retrospective cohort study. Deidentified patient encounter parameters were collected for this observation period and separated into pre‐pandemic (weeks 1–10) and early pandemic (weeks 11–20) study periods. Difference‐in‐difference analyses adjusted for week‐specific and year‐specific effects quantified the impact of the COVID‐19 pandemic on care delivery between pre‐pandemic and early pandemic study periods in 2020. Across all GI malignancies, the COVID‐19 pandemic has been associated with a significant decline in the number of patients with new patient visits (NPVs) ( p = 1.2 × 10 −4 ), Radiology encounters ( p = 1.9 × 10 −7 ), Surgery encounters ( p = 1.6 × 10 −3 ), Radiation Oncology encounters ( p = 4.1 × 10 −3 ), and infusion visits (6.1 × 10 −5 ). Subgroup analyses revealed cancer‐specific variations in changes to delivery. Patients with colorectal cancer (CRC) had the most significant decrease in NPVs ( p = 7.1 × 10 −5 ), which was significantly associated with a concomitant decrease in colonoscopies performed during the early pandemic period (r 2 = 0.722, p = 2.1 × 10 −10 ). Conclusions The COVID‐19 pandemic has been associated with significant disruptions to care delivery. While these effects were appreciated broadly across GI malignancies, CRC, diagnosed and managed by periodic screening, has been affected most acutely.

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“…However, 50% of patients may never commence adjuvant chemotherapy due to post-operative complications or poor performance status, and a proportion of patients do not complete the intended course [30,31]. Additionally, with increasing time from surgery to chemotherapy initiation, there may be a reduction in the survival benefit [32], and this is of particular relevance in patients who do not complete the full planned course of adjuvant chemotherapy [33]. These factors, along with other theoretical advantages such as earlier treatment of micro-metastatic disease, the potential to downstage tumors with improved R0 resection rates, and the opportunity to study disease biology prior to subjecting patients to major surgery, led to increased interest in neo-adjuvant treatment strategies.…”

Section: Guidelinesmentioning

confidence: 99%

Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome?

Khakoo

Petrillo

Salati

et al. 2021

Cancers

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Pancreatic ductal adenocarcinoma (PDAC) has an aggressive tumor biology and is associated with poor survival outcomes. Most patients present with metastatic or locally advanced disease. In the 10–20% of patients with upfront resectable disease, surgery offers the only chance of cure, with the addition of adjuvant chemotherapy representing an established standard of care for improving outcomes. Despite resection followed by adjuvant chemotherapy, at best, 3-year survival reaches 63.4%. Post-operative complications and poor performance mean that around 50% of the patients do not commence adjuvant chemotherapy, and a significant proportion do not complete the intended treatment course. These factors, along with the advantages of early treatment of micrometastatic disease, the ability to downstage tumors, and the increase in R0 resection rates, have increased interest in neo-adjuvant treatment strategies. Here we review biomarkers for early diagnosis of PDAC and patient selection for a neo-adjuvant approach. We also review the current evidence for different chemotherapy regimens in this setting, as well as the role of chemoradiotherapy and immunotherapy, and we discuss ongoing trials.

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Association of Timing of Adjuvant Therapy With Survival in Patients With Resected Stage I to II Pancreatic Cancer

Cited by 60 publications

References 52 publications

A Novel Validated Recurrence Stratification System Based on 18F-FDG PET/CT Radiomics to Guide Surveillance After Resection of Pancreatic Cancer

A Novel Validated Recurrence Stratification System Based on 18F-FDG PET/CT Radiomics to Guide Surveillance After Resection of Pancreatic Cancer

Quantifying the impact of the COVID‐19 pandemic on gastrointestinal cancer care delivery

Neoadjuvant Treatment for Pancreatic Adenocarcinoma: A False Promise or an Opportunity to Improve Outcome?

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