Early discontinuation of adjuvant chemotherapy in patients with early-stage pancreatic cancer correlates with inferior survival: A multicenter population-based cohort study

Abstract

Background The current study aimed to determine the association between timing and completion of adjuvant chemotherapy and outcomes in real-world patients with early-stage pancreatic cancer. Methods In this multi-center cohort study patients with early-stage pancreatic cancer who were diagnosed from 2007–2017 and underwent complete resection in the province of Saskatchewan were examined. Cox proportional multivariate analyses were performed for correlation with recurrence and survival. Results Of 168 patients, 71 eligible patients with median age of 69 years and M:F of 37:34 were identified. Median time to the start of adjuvant therapy from surgery was 73 days. Of all patients, 49 (69%) patients completed adjuvant chemotherapy and 22 (31%) required early treatment discontinuation. Median recurrence-free survival of patients who completed treatment was 22 months (95%CI:15.8–28.2) vs. 9 months (3.3–14.7) if treatment was discontinued early (P<0.001). Median overall survival of those who completed treatment was 33 (17.5–48.5) vs. 16 months (17.5–48.5) with early treatment discontinuation (P<0.001). In the multivariate analysis, treatment discontinuation was significantly correlated with recurrent disease, hazard ratio (HR), 2.57 (1.41–4.68), P = 0.002 and inferior survival, HR, 2.55 (1.39–4.68), P = 0.003. No correlation between treatment timing and survival was noted. Conclusions Early discontinuation but not the timing of adjuvant chemotherapy correlates with inferior outcomes.

Photodynamic Stromal Depletion in Pancreatic Ductal Adenocarcinoma

“…However, 30–40% of patients fail to receive adjuvant chemotherapy due to postoperative complications [ 22 , 23 , 24 ] or early disease progression [ 25 , 26 ]. Of those that do begin postoperative chemotherapy, many fail to complete the course due to toxicity and decrease in performance status [ 27 , 28 ]. Ultimately, 60–75% of patients receiving FFX and other chemotherapies soon relapse [ 29 , 30 , 31 , 32 ], with the median overall survival (OS) following surgical resection and CT being ~20–40 months [ 33 , 34 , 35 ].…”

Risk Factors for Early Treatment Discontinuation Due to Toxicity Among Patients With Metastatic Castration-resistant Prostate Cancer Receiving Androgen Receptor–targeted Therapy

“…Early discontinuation of systemic therapy for any cause has been shown to decrease progression-free survival and overall survival in patients with solid tumors. 25,26 In addition, predictors of treatment discontinuation may help providers avoid expensive and timeconsuming treatment plans and opt for more cost-effective treatments of prostate cancer. 27 Our work aims to identify predictors of treatment discontinuation due to toxicity in patients with prostate cancer undergoing ART.…”

“…The ability to identify patients with mCRPC at risk of early discontinuation in their treatment course can prevent future morbidity and mortality. Early discontinuation of systemic therapy for any cause has been shown to decrease progression-free survival and overall survival in patients with solid tumors 25,26 . In addition, predictors of treatment discontinuation may help providers avoid expensive and time-consuming treatment plans and opt for more cost-effective treatments of prostate cancer 27 .…”