Piotr Wysocki: IPMN-derived pancreatic cancer patients benefit from adjuvant chemotherapy only with nodal involvement and elevated preoperative CA19-9

Piotr Wysocki recently shared a post on LinkedIn:

“A recent international multicenter study published in the Journal of Clinical Oncology by Habib Joseph R et al. investigated the impact of adjuvant chemotherapy on resected intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC). The study aimed to clarify the role of adjuvant chemotherapy in treating IPMN-derived PDAC, a topic with limited evidence due to the biological distinction between this cancer type and other forms of PDAC.

The retrospective cohort study, conducted between 2005 and 2018, included 1,031 patients from 16 centers. The researchers employed Cox regressions, Kaplan-Meier curves, and other statistical methods to analyze overall survival (OS) and identify factors influencing the administration of adjuvant chemotherapy.

Nodal disease and elevated levels of carbohydrate antigen 19-9 (CA19-9) were associated with worse OS, but these patients significantly benefited from adjuvant chemotherapy.

The study found that adjuvant chemotherapy improved OS in patients with node-positive disease

• N0 (HR, 0.87 [95% CI, 0.50 to 1.51])
• N1 (HR, 0.26 [95% CI, 0.12 to 0.60])
• N2 (HR, 0.18 [95% CI, 0.07 to 0.47])

Based on these findings, the study suggests that 18.1% of patients may be undertreated and 61.2% may be overtreated with adjuvant chemotherapy. The researchers also proposed a decision tree to categorize patients and guide treatment decisions.

It seems that adjuvant chemotherapy may be beneficial for certain patient subgroups, such as those with node-positive disease and elevated CA19-9, there is no associated survival benefit for others, such as node-negative patients. Further randomized controlled trials are needed to validate these findings.”

Source: Piotr Wysocki/LinkedIn

About Piotr Wysocki