The impact of immunotherapy on the survival of pancreatic adenocarcinoma patients who received definitive surgery of the pancreatic tumor: a retrospective analysis of the National Cancer Database

Abstract

Background: Immunotherapy has paved the way for new therapeutic opportunities in cancer but has failed to show any efficacy in Pancreatic Adenocarcinoma (PDAC), and its therapeutic role remains unclear. The objective of this study is to examine the impact of immunotherapy in combination with chemotherapy, RT, and chemoradiation on the overall survival (OS) of PDAC patients who received definitive surgery of the tumor using the National Cancer Database (NCDB). Methods: Patients with PDAC who received definitive surgery of the pancreatic tumor and were diagnosed between 2004 and 2016 from the NCDB were identified. Cox proportional hazard analysis was used to assess the survival difference between patients who received chemotherapy plus immunotherapy and chemoradiation therapy plus immunotherapy and their counterparts who only receive these treatments without immunotherapy. The multivariable analysis was adjusted for age of diagnosis, race, sex, place of living, income, education, treatment facility type, insurance status, year of diagnosis, and treatment types such as chemotherapy and radiation therapy. Results: In total, 63,154 PDAC patients who received definitive surgery of the tumor were included in the analysis. Among the 63,154 patients, 636 (1.01%) received immunotherapy. Among patients who received chemotherapy (21,355), and chemoradiation (21,875), 157/21,355 (0.74%) received chemotherapy plus immunotherapy, and 451/21, 875 (2.06%) received chemoradiation plus immunotherapy. Patients who received chemoradiation plus immunotherapy had significantly improved median OS compared to patients who only received chemoradiation with an absolute median OS benefit of 5.7 [29.31 vs. 23.66, p < 0.0001] months. In the multivariable analysis, patients who received immunotherapy had significantly improved OS compared to patients who did not receive immunotherapy (HR: 0.900; CI: 0.814-0.995; P < 0.039). Patients who received chemoradiation plus immunotherapy had significantly improved OS compared to their counterparts who only received chemoradiation without immunotherapy (HR: 0.852 CI: 0.757-0.958; P < 0.008).

Cancer of the Pancreas: An Integrative Review on Treatment

“…Surgical resection is the treatment that offers a potential cure for patients with pancreatic cancer and, when associated with adjuvant treatment, it demonstrates better results related to the survival rate 5 . However, only 15-20% are able to perform tumor resection and are associated with a very low 5-year survival rate after the surgical procedure around 10-20% with an average of 24 months 6 . In addition, neoadjuvant therapies and innovative techniques of immunotherapies have shown promising results, however, more studies are needed to prove their effectiveness 5,6 .…”

“…However, only 15-20% are able to perform tumor resection and are associated with a very low 5-year survival rate after the surgical procedure around 10-20% with an average of 24 months 6 . In addition, neoadjuvant therapies and innovative techniques of immunotherapies have shown promising results, however, more studies are needed to prove their effectiveness 5,6 .…”

“…Therefore, within this scope of research, there are great expectations for new treatments for pancreatic neoplasia, however, the therapeutic role of this type of therapy still remains uncertain. 6…”

Next Generation of Cancer Drug Repurposing: Therapeutic Combination of Aspirin and Oseltamivir Phosphate Potentiates Gemcitabine to Disable Key Survival Pathways Critical for Pancreatic Cancer Progression

“…Over the past five decades, there have been minimal improvements in treatment outcomes due to ineffective screening and early detection methods capable of identifying pancreatic cancer in a pre-malignant stage [4]. Clinical treatment options include surgical resection, neoadjuvant and adjuvant chemotherapy, radiation, and immunotherapy [5][6][7]. Unfortunately, heterogeneous cancer cell populations in primary tumors and secondary micro-metastases render them resistant to cytotoxic therapies [8,9].…”

PET imaging and treatment of pancreatic cancer peritoneal carcinomatosis after subcutaneous intratumoral administration of a novel oncolytic virus, CF33-hNIS-antiPDL1

“…To improve upon the 10% overall survival (OS) in PDAC, immunotherapy alone or combined with chemotherapy are under intense investigation. 8 , 9 Two promising groups of immunotherapeutic agents are oncolytic viruses (OVs) and immune checkpoint inhibitors (ICIs). 10 OVs have several key properties that make them strong anticancer agents.…”