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Adjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma After Pathologic Complete Response to Neoadjuvant Treatment: Necessary or Overtreatment?
Abolfazl Salari, MD1, Emily E. Witt, MD, MSc1, Chukwuma N. Eruchalu, MD1, Mario O’Connor, MD, MPH1, Jiping Wang, MD, PhD1, George Molina, MD, MPH1 1Division of Surgical Oncology, Department of Surgery, Mass General Brigham, Boston, MA, USA
Background: Neoadjuvant treatment (NAT) followed by pancreatectomy is an important strategy to improve outcomes in patients with borderline resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC). Debate persists regarding the value of adjuvant chemotherapy (AC) in patients achieving pathologic complete response (PCR) after NAT. We evaluated whether AC was associated with survival among patients achieving PCR after NAT and pancreatectomy. Methods: The National Cancer Database was queried for patients with stage I–III PDAC diagnosed between 2010 and 2021 who received NAT and pancreatectomy. Kaplan-Meier and multivariable Cox regression analyses evaluated factors associated with overall survival (OS) based on PCR status and AC administration. Results: Among 15,113 patients who met the inclusion criteria, 509 (3.4%) achieved PCR. Patients who achieved PCR had significantly higher median OS than those who did not (105.6 vs 25.9 months, p < 0.001). Among patients who achieved PCR, multivariable analysis revealed no significant difference in OS between those who received AC and those who did not (hazard ratio [HR], 0.95; 95% CI, 0.60-1.50; p=0.83) (Figure 1A). However, among patients without PCR, receiving AC was associated with higher OS (HR, 0.80; 95% CI, 0.76-0.84; p < 0.001) (Figure 1B). Conclusion: Among PDAC patients with PCR after NAT, AC was not associated with improved OS, whereas AC was associated with improved OS among patients without PCR, guiding individualized treatment recommendations after surgery.
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