Racial Disparity in Pathologic Response following Neoadjuvant Chemotherapy in Resected Pancreatic Cancer: A Multi-Institutional Analysis from the Central Pancreatic Consortium

Ogobuiro, Ifeanyichukwu; Collier, Amber L.; Khan, Khadeja; Silva, Iago De Castro; Kwon, Deukwoo; Wilson, Gregory C.; Schwartz, Patrick B.; Parikh, Alexander A.; Hammill, Chet W.; Kim, Hong Joo; Kooby, David A.; Abbott, Daniel E.; Maithel, Shishir K.; Snyder, Rebecca A.; Ahmad, Syed A.; Merchant, Nipun B.; Datta, Jashodeep

doi:10.1245/s10434-022-12741-4

Cited by 7 publications

(4 citation statements)

References 34 publications

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“…In other diseases such as colorectal, pancreatic, and breast carcinoma, there have been reports of racial disparities in pathologic complete response rates for those receiving neoadjuvant chemotherapy. [40][41][42] It is unknown whether similar differences might be observed in patients with locally advanced vulvar cancer treated with cisplatin, gemcitabine, and IMRT. The applicability of our results needs to be confirmed in a larger, more diverse population.…”

Section: Discussionmentioning

confidence: 99%

Phase II Trial of Cisplatin, Gemcitabine, and Intensity-Modulated Radiation Therapy for Locally Advanced Vulvar Squamous Cell Carcinoma: NRG Oncology/GOG Study 279

Horowitz,

Deng,

Peterson

et al. 2024

JCO

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PURPOSE To assess efficacy and toxicity of cisplatin (C) and gemcitabine (G) with intensity-modulated radiation therapy (IMRT) in patients with locally advanced vulvar cancer not amenable to surgery. METHODS Patients enrolled in a single-arm phase II study. Pretreatment inguinal-femoral nodal assessment was performed. Sixty-four Gy IMRT was prescribed to the vulva, with 50-64 Gy delivered to the groins/low pelvis. Radiation therapy (RT) plans were quality-reviewed pretreatment. C 40 mg/m2 and G 50 mg/m2 were administered once per week throughout IMRT. Complete pathologic response (CPR) was the primary end point. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and adverse events were assessed with Common Terminology Criteria for Adverse Events v 4.0. RESULTS Fifty-seven patients enrolled, of which 52 were evaluable. The median age was 58 years (range, 25-58), and 94% were White. Forty (77%) had stage II or III disease, and all had squamous histology. A median of six chemotherapy cycles (range, 1-8) were received. Eighty-five percent of RT plans were quality-reviewed with 100% compliance to protocol. Seven patients came off trial because of toxicity or patient withdrawal. Of 52 patients available for pathologic assessment, 38 (73% [90% CI, 61 to 83]) achieved CPR. No pelvic exenterations were performed. With a median follow-up of 51 months, the 12-month PFS was 74% (90% CI, 62.2 to 82.7) and the 24-month OS was 70% (90% CI, 57 to 79). The most common grade 3 or 4 adverse events were hematologic toxicity and radiation dermatitis. There was one grade 5 event unlikely related to treatment. CONCLUSION Weekly C and G concurrent with IMRT sufficiently improved CPR in women with locally advanced vulvar squamous cell carcinoma not amenable to surgical resection.

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Section: Discussionmentioning

confidence: 99%

Phase II Trial of Cisplatin, Gemcitabine, and Intensity-Modulated Radiation Therapy for Locally Advanced Vulvar Squamous Cell Carcinoma: NRG Oncology/GOG Study 279

Horowitz,

Deng,

Peterson

et al. 2024

JCO

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“…Third, a Cox proportional hazards regression analysis investigating potential factors associated with RFS was not performed because of heterogeneity in local follow-up strategies among centers. Fourth, information about patients’ race and presence of BRCA germline mutations were not collected or available, whereas these factors seem to be of relevance for the chance to achieve major pathological response . Fifth, the number of patients with R1 was relatively low (17%), which could be explained by different local protocols for which not all specimen surfaces were assessed.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, information about patients' race and presence of BRCA germline mutations were not collected or available, whereas these factors seem to be of relevance for the chance to achieve major pathological response. 59,60 Fifth, the number of patients with R1 was relatively low (17%), which could be explained by different local protocols for which not all specimen surfaces were assessed. Sixth, serum bilirubin levels were not collected; therefore, serum CA 19-9 levels might be reactively elevated in some patients due to hyperbilirubinemia.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Pathological Complete Response in Patients With Resected Pancreatic Adenocarcinoma After Preoperative Chemotherapy

Stoop,

Oba,

et al. 2024

JAMA Netw Open

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ImportancePreoperative chemo(radio)therapy is increasingly used in patients with localized pancreatic adenocarcinoma, leading to pathological complete response (pCR) in a small subset of patients. However, multicenter studies with in-depth data about pCR are lacking.ObjectiveTo investigate the incidence, outcome, and risk factors of pCR after preoperative chemo(radio)therapy.Design, Setting, and ParticipantsThis observational, international, multicenter cohort study assessed all consecutive patients with pathology-proven localized pancreatic adenocarcinoma who underwent resection after 2 or more cycles of chemotherapy (with or without radiotherapy) in 19 centers from 8 countries (January 1, 2010, to December 31, 2018). Data collection was performed from February 1, 2020, to April 30, 2022, and analyses from January 1, 2022, to December 31, 2023. Median follow-up was 19 months.ExposuresPreoperative chemotherapy (with or without radiotherapy) followed by resection.Main Outcomes and MeasuresThe incidence of pCR (defined as absence of vital tumor cells in the sampled pancreas specimen after resection), its association with OS from surgery, and factors associated with pCR. Factors associated with overall survival (OS) and pCR were investigated with Cox proportional hazards and logistic regression models, respectively.ResultsOverall, 1758 patients (mean [SD] age, 64 [9] years; 879 [50.0%] male) were studied. The rate of pCR was 4.8% (n = 85), and pCR was associated with OS (hazard ratio, 0.46; 95% CI, 0.26-0.83). The 1-, 3-, and 5-year OS rates were 95%, 82%, and 63% in patients with pCR vs 80%, 46%, and 30% in patients without pCR, respectively (P &lt; .001). Factors associated with pCR included preoperative multiagent chemotherapy other than (m)FOLFIRINOX ([modified] leucovorin calcium [folinic acid], fluorouracil, irinotecan hydrochloride, and oxaliplatin) (odds ratio [OR], 0.48; 95% CI, 0.26-0.87), preoperative conventional radiotherapy (OR, 2.03; 95% CI, 1.00-4.10), preoperative stereotactic body radiotherapy (OR, 8.91; 95% CI, 4.17-19.05), radiologic response (OR, 13.00; 95% CI, 7.02-24.08), and normal(ized) serum carbohydrate antigen 19-9 after preoperative therapy (OR, 3.76; 95% CI, 1.79-7.89).Conclusions and RelevanceThis international, retrospective cohort study found that pCR occurred in 4.8% of patients with resected localized pancreatic adenocarcinoma after preoperative chemo(radio)therapy. Although pCR does not reflect cure, it is associated with improved OS, with a doubled 5-year OS of 63% compared with 30% in patients without pCR. Factors associated with pCR related to preoperative chemo(radio)therapy regimens and anatomical and biological disease response features may have implications for treatment strategies that require validation in prospective studies because they may not universally apply to all patients with pancreatic adenocarcinoma.

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“…Notably, there has been a gradual increase in incidence among people under 50 in recent years. While numerous studies have focused on treatment e cacy and mortality rates of pancreatic cancer [9][10][11]. However, there are very limited studies on the differences in incidence and survival of pancreatic cancer by age, gender, race, and stage at diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Race/Ethnicity, Age, Gender Disparities among Pancreatic Cancer Patients: A Study based on SEER Database

qing,

Xu,

Huang

et al. 2024

Preprint

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Background: Pancreatic cancer is one of the most common malignancies of the digestive system. This study aimed to explore the disparities in incidence and survival across various races, ages, and genders. Methods: Data from the SEER 17 Registries Database, encompassing primary malignant pancreatic cancer cases diagnosed from 2016 to 2020, were analyzed. This study compared patients under the age of 50 with the whole population. Chi-square test evaluated the statistical significance of disparities in race/ethnicity, age, gender, cancer stages, and survival times.. Kaplan-Meier survival curve assessed survival differences by race/ethnicity, age, and gender, and using Annual Average Percentage Change to assess incidence trends. Results:The study included 33,151 patients, comprising 21,309 (64.2%) Whites, 3,817 (11.6%) Blacks, 207 (0.6%) American Indian/Alaska Natives, 2,984 (9.0%) Asians or Pacific Islanders, and 4,780 (14.4%) Hispanics. The findings revealed significant disparities in incidence and mortality rates among different racial and ethnic groups, with Blacks demonstrated notably higher rates. Most diagnosed with pancreatic cancer were elderly,, mainly concentrated in 50-69 years old, patients under 50 had higher survival rate than other age groups. The number of male patients was higher than that of female, with 52.5% of males and 47.4% of females. However, gender-based survival differences in patients under 50 were insignificant. Conclusion: The study revealed significant differences in incidence and survival rate among patients. These findings are important to further understand the factors that affect pancreatic cancer, and enhance the monitoring of people at high risk.

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Racial Disparity in Pathologic Response following Neoadjuvant Chemotherapy in Resected Pancreatic Cancer: A Multi-Institutional Analysis from the Central Pancreatic Consortium

Cited by 7 publications

References 34 publications

Phase II Trial of Cisplatin, Gemcitabine, and Intensity-Modulated Radiation Therapy for Locally Advanced Vulvar Squamous Cell Carcinoma: NRG Oncology/GOG Study 279

Phase II Trial of Cisplatin, Gemcitabine, and Intensity-Modulated Radiation Therapy for Locally Advanced Vulvar Squamous Cell Carcinoma: NRG Oncology/GOG Study 279

Pathological Complete Response in Patients With Resected Pancreatic Adenocarcinoma After Preoperative Chemotherapy

Race/Ethnicity, Age, Gender Disparities among Pancreatic Cancer Patients: A Study based on SEER Database

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