The findings of the European Study Group for Pancreatic Cancer (ESPAC-1) clinical trial and championed by surgeon John Neoptolemos of Liverpool University more than a decade ago challenged the assumption that chemotherapy combined with radiation was a superior regimen after pancreatic cancer (ductal adenocarcinoma of the pancreas) surgery. The chemotherapy alone arm of this trial (using bolus 5-fluorouracil with folinic acid) showed improved survival advantage over the multi-modal (chemoradiation) arm post-surgery for cancer of the pancreas.
But subsequently, aspects of the clinical trial including the conclusions of ESPAC-1 have in turn been challenged. And the debate including dueling non-dispositive research findings back and forth has continued to rage. We have covered this matter HERE and HERE.
Now comes an interesting study by Lipscomb and colleagues from the Department of Surgery at Emory University as published in the October 2013 issue of the Annals of Surgical Oncology. These researchers surveyed and queried the U.S. National Cancer Data Base in terms of overall survival, reviewing the results of more than eleven thousand patients who had received pancreatic cancer surgery over a four year period (1998 – 2002). They developed propensity scores to help produce matched samples for those patients receiving adjuvant chemotherapy versus chemoradiation versus no adjuvant therapy.
The authors found that adjuvant chemoradiation offered the longest duration survival advantage (overall survival) over chemotherapy and no-adjuvant-therapy with a hazard ratio of 0.70 (95% CI of 0.61 – 8.0).
This study is pretty strong tea – and should serve as ammunition in the adjuvant therapy wars. It is possible, as earlier research has hinted, that certain variables may mitigate toward one approach or another. In the meantime, we expect that the debate to carry on for now.
Nevertheless, this clever research work by the Emory University group is powerful dispassionate evidence for the possible superiority of chemoradiation for the adjuvant treatment of pancreatic cancer.
Dale O’Brien, MD