Treatment with chemotherapy before surgery has shown survival rates of 84 percent.
Pancreatic cancer: Chemo before surgery improves survival rates.
Published in The Lancet Gastroenterology & Hepatology, the study was conducted by the University of Liverpool on behalf of the European Study Group for Pancreatic Cancer (ESPAC) and supported by Cancer Research UK.
Pancreatic cancer is a difficult tumor to treat and surgery is the preferred treatment. When the tumor involves local blood vessels (variant known as “borderline resectable”) the possibility of surgical removal is less than 50% and the results are poor. However, using chemotherapy or chemoradiotherapy before attempting surgery may improve survival .
The ESPAC-5 study aimed to compare the use of three different types of short-term neoadjuvant therapy (therapy given before main treatment) versus immediate surgery in patients with borderline resectable pancreatic cancer, to see if this approach could improve patient outcomes. The team recruited 90 patients in the UK and Germany between 2014 and 2018, randomly assigned them to different treatment groups, and followed them up for 12 months.
Some patients had surgery as their first treatment, some had chemotherapy before surgery, and still others had a combination of chemotherapy and radiation therapy (chemoradiotherapy) before surgery. The researchers found that neoadjuvant therapy provided a significant survival benefit to patients. The 1-year overall survival rate was 84% for FOLFIRINOX, 78% for gemcitabine plus capecitabine , and 60% forfor capecitabine-based chemoradiation, compared with 39% for immediate surgery. There were no significant differences in surgical excision rates between the surgical and neoadjuvant patient groups, and the treatments were all well tolerated.
Future studies will focus on the type and duration of neoadjuvant therapy in borderline pancreatic cancer. “A growing number of studies are showing that giving some chemotherapy before surgery can radically improve the quality of life of cancer patients. The ESPAC5 study shows exciting new evidence that chemotherapy before surgery could benefit pancreatic cancer patients when diagnosed early enough,” explain the researchers.
- Immediate surgery compared with short-course neoadjuvant gemcitabine plus capecitabine, FOLFIRINOX, or chemoradiotherapy in patients with borderline resectable pancreatic cancer (ESPAC5): a four-arm, multicentre, randomized, phase 2 trial (thelancet.com)