Pancreatic cancer patients who underwent chemotherapy before and after surgery had better survival rates compared to those who had surgery followed by chemotherapy, a recent study conducted by researchers at Yale Cancer Center (YCC) and Yale School of Medicine revealed.
The study, recently published in JAMA Oncology, focused on patients diagnosed with pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer constituting 90% of cases. PDAC is known for its aggressive nature and high mortality rates, projected to become the second leading cause of cancer-related deaths in the U.S. by 2030.
The study findings offer hope for the 15 to 20% of pancreatic cancer patients who are eligible for surgical treatment. The trial involved a modified version of the chemotherapy regimen FOLFIRINOX, which is a combination of leucovorin calcium, fluorouracil, irinotecan hydrochloride, and oxaliplatin that was approved in 2011 for metastatic pancreatic cancer.
Participants in the trial received six cycles of the modified FOLFIRINOX before surgery and an additional six cycles after surgery. This adapted protocol used slightly reduced doses of FOLFIRINOX to enhance tolerability without compromising outcomes, as shown in a previous study from 2016.
Out of the 46 patients who began the modified treatment, 37 completed all six pre-surgery chemotherapy cycles, and 27 underwent successful tumor removal surgeries. The 12-month progression-free survival rate for all patients was 67%, signifying significant progress in managing the disease. Moreover, 59% of patients survived for at least two years after completing the full chemotherapy and surgical treatment plan.
The trial, initiated by senior author Dr. Jill Lacy in 2014, was the first of its kind for PDAC patients. The primary aim of the study was to achieve a 12-month progression-free survival rate of at least 50%.
Dr. Michael Cecchini, the study’s lead author and the colorectal program co-director at the Center for Gastrointestinal Cancers at Smilow Cancer Hospital and YCC, emphasized the need to shift chemotherapy to an earlier stage in the treatment process for better patient outcomes.
Advanced techniques, such as monitoring circulating tumor DNA (ctDNA) and utilizing the biomarker keratin 17, were employed to track treatment progress and predict outcomes. Notably, patients with detectable ctDNA four weeks post-surgery had poorer progression-free survival compared to those with undetectable ctDNA levels.
Cecchini stressed the necessity for larger randomized clinical trials to further explore the benefits of FOLFIRINOX administered before surgery for patients with operable PDAC.
He highlighted, “Despite evolving standards of care for this aggressive form of pancreatic cancer, the promising data from our study warrant further investigation in larger trials.”
