ASO Author Reflections: Chemopreventive Agents After Pancreatic Resection for Ductal Adenocarcinoma
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Chemopreventive Agents After Pancreatic Resection for Ductal Adenocarcinoma Domenico Tamburrino, MD, PhD1 and Massimo Falconi, MD1,3
, Giovanni Guarneri, MD1, Gabriele Capurso, MD, PhD2,
1
Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy; 2Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy; 3‘‘Vita-Salute San Raffaele’’ University, Milan, Italy
PAST Despite improvements in oncological treatment, pancreatic ductal adenocarcinoma (PDAC) continues to have a poor prognosis after curative resection. In this context, cancer chemoprevention using natural or synthetic substances to inhibit, retard, or reverse carcinogenesis has recently been advocated. The possible preventive effect of aspirin,1 metformin,2 and statins3 during oncogenesis has been demonstrated in several models of human cancer;4 however, the chemopreventive effect of these drugs on patients with PDAC has been poorly investigated. PRESENT This retrospective study5 analyzed the effect of metformin, aspirin, and statins on disease-free and diseasespecific survival in a cohort of 430 patients who underwent pancreatic resection between 2015 and 2018. While the chronic assumption of statins is not significantly associated with a better prognosis, aspirin assumption was an independent prognostic factor of prolonged disease-free survival (DFS). On the other hand, metformin chronic use likely correlates with improved DFS, but without reaching statistical significance. A possible explanation for this
protective effect on the recurrence of aspirin and metformin originates from the analysis of pathological features among chronic users of the different drugs, particularly regarding nodal status. In fact, a statistically significant higher rate of N0 status among aspirin and metformin patients was observed. FUTURE The retrospective design of this study did not allow for the retrieval of information on the precise duration of each treatment, as well as the dosages and subtypes of the different classes of drugs. A specific ongoing study, the CAOS study (registered on ClinicalTrials.gov; NCT04245644), was designed to explore this issue in a prospective fashion; however, given its prospective design, many confounding factors will be excluded. Another point of discussion is the possible molecular explanation of the protective effect on recurrence. In this optic, a prospective trial would be needed to better assess the molecular pathways influenced by aspirin and metformin assumption. DISCLOSURES Domenico Tamburrrino, Giovanni Guarneri, Gabriele Capurso, and Massimo Falconi declare no conflicts of interest.
REFERENCES
Ó Society of Surgical Oncology 2020 First Received: 30 August 2020 Accepted: 1 September 2020 D. Tamburrino, MD, PhD e-mail: [email protected]
1. Capurso G, Schu¨nemann HJ, Ter
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