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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2018

01-04-2018 | Pancreatic Tumors

Gemcitabine and Taxane Adjuvant Therapy with Chemoradiation in Resected Pancreatic Cancer: A Novel Strategy for Improved Survival?

Authors: Zaheer S. Kanji, MD, MSc, FRCSC, Alicia M. Edwards, MBA, Margaret T. Mandelson, MPH, PhD, Nadav Sahar, MD, Bruce S. Lin, MD, Kasra Badiozamani, MD, Guobin Song, MD, Adnan Alseidi, MD, EdM, Thomas R. Biehl, MD, Richard A. Kozarek, MD, William S. Helton, MD, Vincent J. Picozzi, MD, MMM, Flavio G. Rocha, MD

Published in: Annals of Surgical Oncology | Issue 4/2018

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Abstract

Background

Gemcitabine-taxane combination chemotherapy has demonstrated a survival benefit clinically in metastatic pancreatic cancer (PC). The authors present their experience with gemcitabine and docetaxel (gem/tax)-based adjuvant treatment (Rx) after surgery with curative intent.

Methods

Patients with de novo resectable PC from January 2010 to December 2015 were identified from the authors’ institutional database and registry. The study included only patients who received gem/tax as their initial Rx administered exclusively at the authors’ institution with or without chemoradiation (CRTx). Survival analysis was performed using Kaplan–Meier methods, and prognostic factors were investigated by Cox proportional hazard modeling.

Results

Of 102 patients identified, 58 met the study criteria. The median age at diagnosis was 65 years, with 55% of the patients undergoing an R1 resection (margin ≤ 1 mm). Tumor characteristics included a median tumor size of 28 mm, a poor differentiation rate of 54%, and a lymph node positivity of 67%. Most of the patients (90%, 52/58) completed 80% or more of the 24 week Rx. Of these patients, 71% received post-gem/tax CRTx Rx. Grade 3 or 4 toxicity was observed in 52% of the patients. The median follow-up period was 51.2 months, and the observed median overall survival (OS) was 52 months [95% confidence interval (CI) 27.4–not reached]. The actuarial 5-year OS was 49% (95% CI 33.7–63.4%). In the multivariate analysis, an R1 resection and American Joint Committee on Cancer (AJCC) stage 2 versus stage 1 disease were negatively associated with OS, whereas administration of CRTx was positively associated with OS.

Conclusions

Adjuvant gem/tax with or without CRTx is feasible, with a favorable OS. Future prospective studies of gem/taxane-based adjuvant Rx for PC are warranted.
Appendix
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Metadata
Title
Gemcitabine and Taxane Adjuvant Therapy with Chemoradiation in Resected Pancreatic Cancer: A Novel Strategy for Improved Survival?
Authors
Zaheer S. Kanji, MD, MSc, FRCSC
Alicia M. Edwards, MBA
Margaret T. Mandelson, MPH, PhD
Nadav Sahar, MD
Bruce S. Lin, MD
Kasra Badiozamani, MD
Guobin Song, MD
Adnan Alseidi, MD, EdM
Thomas R. Biehl, MD
Richard A. Kozarek, MD
William S. Helton, MD
Vincent J. Picozzi, MD, MMM
Flavio G. Rocha, MD
Publication date
01-04-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6334-8

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