CA19-9 Change During Neoadjuvant Therapy May Guide the Need for Additional Adjuvant Therapy Following Resected Pancreati
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ORIGINAL ARTICLE – PANCREATIC TUMORS
CA19-9 Change During Neoadjuvant Therapy May Guide the Need for Additional Adjuvant Therapy Following Resected Pancreatic Cancer Hao Liu, MD, PhD1, Mazen S. Zenati, MD, PhD2, Caroline J. Rieser, MD1, Amr Al-Abbas, MD1, Kenneth K. Lee, MD1, Aatur D. Singhi, MD, PhD3, Nathan Bahary, MD, PhD4, Melissa E. Hogg, MD5, Herbert J. Zeh III, MD6, and Amer H. Zureikat, MD1 1
Division of Gastrointestinal Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; 2Department of Surgery and Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, PA; 3 Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA; 4Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; 5Department of Surgery, NorthShore University Health System, Chicago, IL; 6 Department of Surgery, University of Texas Southwestern, Dallas, TX
ABSTRACT Background. Neoadjuvant therapy (NAT) is increasingly utilized for pancreatic cancer, however the added benefit of adjuvant therapy (AT) in this setting is unknown. We hypothesized that the magnitude of CA19-9 response to NAT can guide the need for further AT in resected pancreatic cancer. Methods. CA19-9 secretors who received NAT for pancreatic cancer during 2008–2016 at a single institution were analyzed and CA19-9 response (difference between pre- and post-NAT values) was measured. Kaplan–Meier estimators and Cox proportional hazard ratio models were used to determine the optimal CA19-9 response at which AT ceases to confer any additional survival benefit after NAT. Results. A total of 241 patients (mean age 65.4 years, 50% female) with complete CA19-9 data who underwent NAT followed by resection were analyzed. In a cohort of patients (n = 78) in whom CA19-9 normalized with a
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08468-9) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 2 October 2019 A. H. Zureikat, MD e-mail: [email protected]
decrease [ 50% after NAT (optimal responders), AT was not associated with additional survival benefit (40.6 vs. 39.0 months, p = 0.815). Conversely, in the cohort of patients (n = 163) in whom NAT was not associated with normalization and a decrease of B 50% in CA19-9 (suboptimal responders), receipt of AT was associated with a survival benefit (34.5 vs. 19.1 months, p \ 0.001) following NAT. A Cox proportional hazards model confirmed CA19-9 normalization and decrease [ 50% during NAT to predict no additional survival benefit from AT. Conclusions. The magnitude of CA19-9 response to NAT may predict the need for further AT in resected pancreatic cancer. Prospective studies are needed to elucidate the optimal interplay of NAT and AT in pancreatic cancer.
Pancreatic resection followed by adjuvant therapy (AT) is the current standard of care for pancreatic adenocarcinoma (PDAC).1–4 However, a significant proport
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