Long-term survival improved in advanced pancreatic cancer patients following extended chemotherapy before surgery
Most pancreatic cancers are considered advanced or inoperable when the tumors grow outside the pancreas to encompass veins and arteries. The average survival time is predicted to be 12 to 18 months.
A newly published study by Mayo clinic finds that a pre-surgery treatment plan focusing on three factors including extended chemotherapy before surgery can prolong life years beyond that.
The findings were published today in the Annals of Surgery, the journal of the American Surgical Association and European Surgical Association.
“We now have more advanced surgical techniques and more effective chemotherapy and radiation therapy. We can take all of these advances and put them together to get the outcomes we are looking for”
The study followed 194 patients over seven years who received chemotherapy followed by radiation and surgery. An average survival time of 58.8 months, or just under five years, was achieved. The researchers found that patients with these three factors had significantly longer survival times than those who did not:
- Extended chemotherapy before surgery; the more cycles they had, the longer the survival.
- A CA 19-9 tumor marker that fell to a normal level after chemotherapy.
- A tumor that, when surgically removed, was found to be all or mostly dead due to chemotherapy.
Lead author Mark Truty, M.D., estimates that roughly half of his patients with vein and artery involvement came to him after being told elsewhere that their cancer was inoperable. “We now have more advanced surgical techniques and more effective chemotherapy and radiation therapy. We can take all of these advances and put them together to get the outcomes we are looking for,” says Dr. Truty, an oncologic surgeon at Mayo Clinic in Rochester, Minnesota.
“The goal is to extend patients’ lives and maintain or improve their quality of life.”About 55,000 people in the U.S. are diagnosed with pancreatic cancer each year. In about a third, the tumor has grown outside the pancreas to wrap around veins and arteries which are considered borderline resectable or locally advanced.
Crucial to their care before surgery was finding the right chemotherapy and continuing it until the CA 19-9 tumor marker was normal and positron emission tomography, a form of advanced imaging known as a PET scan, showed the tumor was dead, Dr. Truty said.The more of those three factors patients had, the better they did. Because the three factors were all related to chemotherapy and the response to it, it may be possible to help many more patients achieve them by adjusting their chemotherapy before surgery, Dr. Truty said.
Twenty-nine percent of the patients had all three factors identified in the study; their median survival time has not yet been calculated because more than half are still alive. An additional 29 percent had two factors; their median survival was 58.6 months.Thirty-one percent had one factor and a median survival of 29.7 months. Eleven percent had none of the factors; their median survival was 18.5 months.
